Basic Information
| Provider Information | |||||||||
| NPI: | 1144857673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUIZE | ||||||||
| FirstName: | JOSH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18196 EDGEHILL RD | ||||||||
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| City: | RICHMOND | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563688381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202488383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 ELM ST N | ||||||||
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| City: | ONAMIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563597901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205323154 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2020 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 13454 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.