1598916025 NPI number — KRISTIN D. BOUCHE CRNA

Table of content: KRISTIN D. BOUCHE CRNA (NPI 1598916025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598916025 NPI number — KRISTIN D. BOUCHE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCHE
Provider First Name:
KRISTIN
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSON
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598916025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 PEELER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49008-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-345-8618
Provider Business Mailing Address Fax Number:
269-345-1508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ANESTHESIA PRACTICE CONSULTANTS, PC
Provider Second Line Business Practice Location Address:
3333 EVERGREEN DR NE
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-364-4200
Provider Business Practice Location Address Fax Number:
616-364-7347
Provider Enumeration Date:
10/02/2008

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:  4704181397 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4704181397 . This is a "MICHIGAN LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".