Jacquelyn Sue Johnson-Kruse, R.N.
Individual provider Active NPI General Practice Registered Nurse · Arena, WI
NPI 1013122902 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1013122902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Registered Nurse 163WG0000X
- License
- 163WG0000X (WI)
- Practice address
- 7114 Hayward Crossing Rd
Arena, WI 53503-9317 - Phone
- (608) 753-2075
- NPI assigned
- May 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 163WG0000X | WI | MD | General Practice Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 163WG0000X | WI | Yes |
Addresses
Primary practice location
7114 Hayward Crossing Rd
Arena, WI 53503-9317
Mailing address
7114 Hayward Crossing Rd
Arena, WI 53503-9317
Phone (608) 753-2075
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3902114320 | Medicaid | WI |
Other providers in Arena, WI
- Andrew Michael Campbell
- Dorothy J Campbell
- Terry Kay Carney
- Dianes Adult Family Home
- Jami Graham
- Pamela Ann Krueger
- Emily Suanne Ruyle
- Amanda Marie Scheel
- Suzette Michele Sharp
- TLC Senior Home Care LLC
All providers in Arena, WI · General Practice Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.