Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5254 | NE |
NPI | 1063439552 |
---|---|
Provider Name | Fredrick Joseph Krause |
First Address | Kearney, NE 68848 |
Second Address | Kearney, NE 68845-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47069737800 | (05) | NE |