MEDICARE: TIFFANY LEIGH GUNDERSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	201392745CRNA	OR
2	367500000X	Certified Registered Nurse Anesthetist	AP60327805	WA

General Provider Information

NPI Number	:	1184960767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LEIGH GUNDERSON CRNA

Provider Business Mailing Address
First Line	:	27809 N SPOTTED RD
Second Line	:
City	:	DEER PARK
State	:	WA
Zip	:	99006-5102
Country	:	US
Telephone Number	:	541-706-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N MULLAN RD STE 204
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6848
Country	:	US
Telephone Number	:	509-900-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2012
Last Update Date	:	01/06/2026

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