Individual
COLLEEN MARY KRUG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
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
Update your record
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