Basic Information
| Provider Information | |||||||||
| NPI: | 1528523206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAUSE | ||||||||
| FirstName: | LONNY | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | APRN , NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N. 500 W. | ||||||||
| Address2: | ATTN. CREDENTIALING | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013548225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1380 E MEDICAL CENTER DR STE 4100 | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847902156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352512900 | ||||||||
| FaxNumber: | 4352512901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9415611-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.