Doctor Name: | MRS. LANA MARIE KRUSE |
NPI Number: | 1407121312 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | 2000175751 |
Business Practice Address: | 100 Medical Plz Suite 1203 Lake St Louis, MO - 633671366 |
Business Phone Number: | 6366255424 |
Business Fax Number: | 6366255431 |
Mailing Address: | 18 Auvergne Dr, LAKE ST LOUIS |
State: | MO |
Postal Code: | 633672030 |
Phone Number: | 6365613179 |
Fax Number: | 6365613179 |
NPI Enumeration Date: | 03/12/2012 |
NPI Last Update Date: | 03/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1006X |
License Number: | 2000175751 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Metabolic |
Taxonomy Definition: |