Basic Information
Provider Information
NPI: 1801880042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRUSE
FirstName: DONALD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1626
Address2:  
City: OCALA
State: FL
PostalCode: 344781626
CountryCode: US
TelephoneNumber: 3528730516
FaxNumber: 3528739726
Practice Location
Address1: 3241 SW 34TH ST
Address2:  
City: OCALA
State: FL
PostalCode: 344747439
CountryCode: US
TelephoneNumber: 3522375906
FaxNumber: 3522378758
Other Information
ProviderEnumerationDate: 09/02/2005
LastUpdateDate: 12/06/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP2047132FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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