Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301096889 | MI |
N | 208000000X | Pediatrician | 62716 | MN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 62716 | MN |
NPI | 1225340565 |
---|---|
Provider Name | Dr. Katherine Elizabeth Kruse |
First Address | Minneapolis, MN 55417 |
Second Address | Minneapolis, MN 55404-4387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 17/03/2018 |