Individual
BRYNN CHARLOTTE KRUKEMYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
900 W SOUTH BOUNDARY ST, PERRYSBURG, OH 43551-5230
(419) 873-6963
Mailing address
506 WEST ST, GENOA, OH 43430
(419) 708-8012
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
50.006703
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50.006703RX
STATE LICENSE
OH
Enumeration date
01/31/2021
Last updated
06/13/2023
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