Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | ME36724 | FL |
NPI | 1326107384 |
---|---|
Provider Name | Dr. Karen Camille Krueger |
First Address | Tallahassee, FL 32308 |
Second Address | Tallahassee, FL 32308-4430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D54607 | (02) | FL |