Individual
COLLEEN MARY KRUG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
10 GEORGE ST, OSWEGO, NY 13126-3276
(315) 598-4790
(315) 593-6195
Mailing address
239 ONEIDA ST, FULTON, NY 13069-1228
(315) 592-0721
(315) 598-4733
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015540
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0764
STAT OF NH LICENSE
NH
01
—
1091403
NCCPA CERTIFICATION
—
Enumeration date
02/01/2010
Last updated
04/25/2012
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