Provider Demographics
NPI:1902963093
Name:KRAUSE, THEADORA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:THEADORA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1834
Mailing Address - Country:US
Mailing Address - Phone:814-943-9889
Mailing Address - Fax:
Practice Address - Street 1:105 31ST ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1834
Practice Address - Country:US
Practice Address - Phone:814-943-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP-005157-M363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health