Basic Information
| Provider Information | |||||||||
| NPI: | 1801813498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUSE | ||||||||
| FirstName: | KAYE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN, MSN, ENP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILSON | ||||||||
| OtherFirstName: | KAYE | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 E DIMOND BLVD | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995152010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075656000 | ||||||||
| FaxNumber: | 9075656000 | ||||||||
| Practice Location | |||||||||
| Address1: | 3841 PIPER ST | ||||||||
| Address2: | SUITE T-345 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075656000 | ||||||||
| FaxNumber: | 9075656000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 11/13/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 980 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 044357401 | 05 | TX | MEDICAID | 044357404 | 05 | TX | MEDICAID | 044357402 | 05 | TX | MEDICAID |