Provider Demographics
NPI:1144627522
Name:KRUEGER, NICOLE (LAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SOUTH ST
Mailing Address - Street 2:STE 311
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3585
Mailing Address - Country:US
Mailing Address - Phone:605-858-9571
Mailing Address - Fax:605-496-7183
Practice Address - Street 1:809 SOUTH ST
Practice Address - Street 2:STE 311
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3585
Practice Address - Country:US
Practice Address - Phone:605-858-9571
Practice Address - Fax:605-496-7183
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist