Organization
URO GYN CONSULTATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY KRUSE MS, APNP (OWNER)
(608) 437-6035
Entity
Organization
Contact information
Practice address
407 N 8TH ST, MOUNT HOREB, WI 53572-1872
(608) 437-5511
Mailing address
2020 COUNTY ROAD Z, BLUE MOUNDS, WI 53517-9629
(608) 647-2138
(608) 437-6035
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
84725-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43961600
—
WI
Enumeration date
06/03/2013
Last updated
06/03/2013
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