1457674640 NPI number — KEVIN P BURMAN CRNA

Table of content: KEVIN P BURMAN CRNA (NPI 1457674640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457674640 NPI number — KEVIN P BURMAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURMAN
Provider First Name:
KEVIN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457674640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-1439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-242-3008
Provider Business Mailing Address Fax Number:
360-807-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 NE KRESKY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-748-8632
Provider Business Practice Location Address Fax Number:
360-748-3869
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN619028 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 46909 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: NUR-RN-LIC-71934 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 201394417CRNA , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: CRNA-0182 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: NURA428 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AP60140049 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20004631 . This is a "MEDICARE ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 500670615 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8923257 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8926234 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: M011004119 . This is a "MEDICARE MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1457674640 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005970 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 324226YWN7 . This is a "MEDICARE NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: R174152 . This is a "MEDICARE OR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CRNA082826 . This is a "NATIONAL CRNA CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: K165387 . This is a "MEDICARE AK" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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