Provider Demographics
NPI:1164644720
Name:KROEGER, MICHELLE MARIE (ARNP, MSN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:KROEGER
Suffix:
Gender:F
Credentials:ARNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23751 HIGHWAY 30
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 ANN ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1128
Practice Address - Country:US
Practice Address - Phone:712-653-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA098229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA251473OtherMIDLANDS CHOICE
IA39339OtherWELLMARK BLUE CROSS BLUE