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Mrs. Marla C. Krueger

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NPI Number Detailed Information

Provider Information:

Name: Mrs. Marla C. Krueger
Gender: F
Provider License Number If Given: 209000624

NPI Information:

NPI: 1407855919
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 6/12/2019

Provider Business Mailing Address:

Address: 1800 N MAIN ST
Wheaton, IL 60187
Phone Number: 6306534240
Fax Number: 6303156557

Provider Business Practice Location Address:

Address: 1800 N MAIN ST
Wheaton, IL 60187
Phone Number: 6306534240
Fax Number: 6303156557

Provider Taxonomy:

Primary: 363L00000X
Secondary (if any): 367A00000X
State: IL

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