Individual
IDA KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 HIGH ST, WAKEFIELD, RI 02879-3103
(401) 789-1422
(401) 782-6810
Mailing address
1 HIGH ST, WAKEFIELD, RI 02879-3103
(401) 789-1422
(401) 782-6810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00985
RI
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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