Basic Information
| Provider Information | |||||||||
| NPI: | 1780663781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUSE | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | PO BOX 8674 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 E MADISON AVE | ||||||||
| Address2: | SUITE 400A | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 9539 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 970018304 | 01 | RR MEDICARE | OTHER | 0109920 | 01 | MN | MEDICA | OTHER | 151319 | 01 | MN | UCARE | OTHER | 66B52KR | 01 | MN | BCBS | OTHER | HP31696 | 01 | MN | HEALTH PARTNERS | OTHER | 1662208 | 01 | AMERICAS PPO | OTHER | 41084933956001C171 | 01 | CHAMPUS | OTHER | 672608900 | 05 | MN | MEDICAID | NA2951025903 | 01 | MN | PREFERRED ONE | OTHER |