MR. JACK ROBERT KRUSE (NPI# 1457987992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1457987992 |
Entity Type | Individual |
Full Name | MR. JACK ROBERT KRUSE |
Credential | SUDPT |
Practice Address |
16715 Aurora Ave N Ste 102 Shoreline WA 98133-5310 |
Mailing Address |
10514 Ne 144th St Kirkland WA 98034-5250 |
Practice Telephone | 2065469766 |
Practice Fax Number | 2065420326 |
Mailing Telephone | 2063847769 |
Enumeration Date | 2020-03-17 |
Last Update Date | 2020-03-17 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 390200000X | Student in an Organized Health Care Education/Training Program | WA | Student, Health Care |
Street Address |
16715 AURORA AVE N STE 102 |
City | SHORELINE |
State | WA |
Zip Code | 98133-5310 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144312877 | Therapeutic Health Services | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2006-09-29 |
1043824899 | Andrea Katherine Arany-kovacs | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2020-08-31 |
1245840891 | Shannon Findlay | Technician, Other | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2020-08-07 |
1689299562 | Erica Lynn Harrison | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2020-06-16 |
1700411758 | Ekaterina Stetsyshin | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2020-03-10 |
1164906699 | Michele Olson Finkelstein | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2018-09-20 |
1437642105 | Juanita C Diaz | Community Health Worker | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2018-06-07 |
1225527831 | Andrew Robert Brazzale | Social Worker | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2018-05-09 |
1396259123 | Franklin Thomas Masteller | Community Health Worker | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2017-12-01 |
1023468964 | Sonya Patrcia Girtman | Counselor | 16715 Aurora Ave N Ste 102, Shoreline, WA 98133-5310 | 2016-06-21 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891339388 | Marni Lynn Hanig | Occupational Therapist | 1900 N 170th St., Shoreline, WA 98133 | 2019-10-29 |
1871074807 | Minju Kim | Counselor | 14332 Burke Ave N, Seattle, WA 98133 | 2018-08-27 |
1821582941 | Hana Alema Misgina | Registered Nurse | 927 N 199th St, Shoreline, WA 98133 | 2018-06-21 |
1588177729 | Julie Benefiel | Pharmacist | 1536 N 115th St. Suite 100, Seattle, WA 98133 | 2017-11-09 |
1730607953 | Aurora Oaks, LLC | Skilled Nursing Facility | 16357 Aurora Avenue North, Shoreline, WA 98133 | 2017-09-08 |
1750801072 | Zoe Ana Cavnar-lewandowski | Counselor | 10700 Meridian Avenue N, Suite G-11, Seattle, WA 98133 | 2017-06-27 |
1851820211 | Adam Lee Gardner Sr. | Acupuncturist | 925 N 163rd Street, Unit B, Shoreline, WA 98133 | 2017-06-08 |
1376085209 | Pamela Ashby | Counselor | 2111 N. Northgateway, 212, Seattle, WA 98133 | 2016-11-09 |
1225584956 | General Dentistry | Dentist | 20109 Aurora Ave N, Ste D, Shoreline, WA 98133 | 2016-09-01 |
1144672668 | Aaron Neubauer | Behavioral Analyst | 13407 Greenwood Ave N, 216c, Seattle, WA 98133 | 2016-07-08 |
Find all providers in zip 98133 |
Taxonomy Code | 390200000X |
Grouping | Student, Health Care |
Classification | Student in an Organized Health Care Education/Training Program |
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
Notes: [1/1/2005: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770120511 | Thi Van Bui I | Student in an Organized Health Care Education/Training Program | 1818 Ne 175th St, Shoreline, WA 98155-5273 | 2019-11-27 |
1376100719 | Brian O'brien Goldberg | Student in an Organized Health Care Education/Training Program | 733 N 150th St, Shoreline, WA 98133-6104 | 2019-05-21 |
1336638113 | Kevin Lester Almojuela Aranas | Student in an Organized Health Care Education/Training Program | 2728 Ne 204th St, Shoreline, WA 98155-1430 | 2018-05-07 |
1679086169 | Jael Weinberg | Student in an Organized Health Care Education/Training Program | 15100 1st Ave Ne, Shoreline, WA 98155-6830 | 2017-11-07 |
1679928220 | Thong Phan | Student in an Organized Health Care Education/Training Program | 1209 Ne 158th St, Shoreline, WA 98155-6339 | 2016-05-02 |
1821442641 | Natasha Geogy | Student in an Organized Health Care Education/Training Program | 829 Nw 205th St, Shoreline, WA 98177-2162 | 2016-04-18 |
1578939021 | Erin Nicole Rasp | Student in an Organized Health Care Education/Training Program | 19710 6th Pl Nw, Shoreline, WA 98177-2531 | 2015-08-19 |
1861878456 | Odawni Alezena Joy Palmer | Student in an Organized Health Care Education/Training Program | 1194 N 198th St, Shoreline, WA 98133-3605 | 2015-08-05 |
1245677871 | Esther Rhee | Student in an Organized Health Care Education/Training Program | 2121 N 188th St, Shoreline, WA 98133-4241 | 2013-05-22 |
1831722602 | Delia Ernst | Student in an Organized Health Care Education/Training Program | 17018 15th Ave Ne, Shoreline, WA 98155-5137 | 2020-02-19 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.