Individual
WAYLAN KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3680 RAMONA DR, RIVERSIDE, CA 92506-0160
(714) 336-0429
Mailing address
3680 RAMONA DR, RIVERSIDE, CA 92506-0160
(714) 336-0429
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
86062
CA
390200000X
Student in an Organized Health Care Education/Training Program
702703
CA
Other
Enumeration date
02/11/2010
Last updated
06/30/2014
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