Provider Demographics
NPI:1033949797
Name:KRAUSE, NATHAN ALEXANDER
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALEXANDER
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3010
Mailing Address - Country:US
Mailing Address - Phone:785-324-1632
Mailing Address - Fax:
Practice Address - Street 1:5301 N HILLSIDE ST.
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219
Practice Address - Country:US
Practice Address - Phone:785-324-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-011482081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine