MEDICARE: NANCY KELLY-CULBERSON 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	202010485CRNA	OR

General Provider Information

NPI Number	:	1245617273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KELLY-CULBERSON CRNA

Provider Business Mailing Address
First Line	:	10340 SW RIDGEVIEW LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-6317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10340 SW RIDGEVIEW LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-6317
Country	:	US
Telephone Number	:	310-251-9801
Fax Number	:

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

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	02/17/2026

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