Provider Demographics
NPI:1881929859
Name:KRAUS, MIRIAM ANNE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ANNE
Last Name:KRAUS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:ANNE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:1717 SHARON RD W
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5663
Mailing Address - Country:US
Mailing Address - Phone:980-859-2113
Mailing Address - Fax:980-859-2113
Practice Address - Street 1:26100 NEWPORT RD
Practice Address - Street 2:SUITE A12 #317
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7002
Practice Address - Country:US
Practice Address - Phone:951-251-5136
Practice Address - Fax:951-541-9495
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751512163WG0000X
NC290620163WG0000X
CA20348363LP2300X, 363LF0000X
NC5008945363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA613404OtherMEDI-CAL