Basic Information
| Provider Information | |||||||||
| NPI: | 1952341026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRUEGER | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 DEMERS AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017801891 | ||||||||
| FaxNumber: | 2186862595 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 S COLUMBIA RD - ALTRU HOSPITAL | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017806000 | ||||||||
| FaxNumber: | 2186862595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R153023-6 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | R21652 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1042684 | 01 | MN | PREFERRED ONE # | OTHER | 127878900 | 05 | MN | MEDICAID | 138H8KR | 01 | MN | MNBCBS # | OTHER | 56110 | 01 | MN | LHS-BANNER HEALTH # | OTHER | HP45236 | 01 | MN | HEALTHPARTNERS # | OTHER | 12721 | 05 | MN | MEDICAID | 133876 | 01 | MN | UCARE # | OTHER | 2003641 | 01 | MN | MEDICA # | OTHER | 27901 | 01 | MN | NDBCBS # | OTHER | R153023-6 | 01 | MN | MN LICENSE | OTHER |