Individual
MR. JACK ROBERT KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
16715 AURORA AVE N STE 102, SHORELINE, WA 98133-5310
(206) 546-9766
(206) 542-0326
Mailing address
10514 NE 144TH ST, KIRKLAND, WA 98034-5250
(206) 384-7769
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
WA
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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