Provider Demographics
NPI:1881756112
Name:KRUIS, DIANE JOY (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JOY
Last Name:KRUIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 30001
Mailing Address - Street 2:MSC 3529 NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CEN
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:505-646-1512
Mailing Address - Fax:505-646-6428
Practice Address - Street 1:CORNER OF STEWART AND BRELAND DR
Practice Address - Street 2:NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-8001
Practice Address - Country:US
Practice Address - Phone:505-646-1512
Practice Address - Fax:505-646-6428
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NMNM89237208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice