MEDICARE: KATHLEEN M DANAHER 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	R1492028	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639174832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M DANAHER CRNA

Provider Business Mailing Address
First Line	:	8681 EAGLE POINT BLVD
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-8628
Country	:	US
Telephone Number	:	651-251-8021
Fax Number	:	651-251-8050

Provider Business Practice Location Address
First Line	:	1925 WOODWINDS DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55125-2270
Country	:	US
Telephone Number	:	651-735-0501
Fax Number	:	651-735-1870

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/01/2010

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