Doctor Name: | DIANE JOY KRUIS |
NPI Number: | 1881756112 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | NM89237 |
Business Practice Address: | Corner Of Stewart And Breland Dr New Mexico State University Student Health Center Las Cruces, NM - 880038001 |
Business Phone Number: | 5056461512 |
Business Fax Number: | 5056466428 |
Mailing Address: | Po Box 30001, Msc 3529 New Mexico State University Student Health Cen LAS CRUCES |
State: | NM |
Postal Code: | 880038001 |
Phone Number: | 5056461512 |
Fax Number: | 5056466428 |
NPI Enumeration Date: | 12/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | NM89237 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |