MEDICARE: KAY KENNETH DUCHOW 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	RNA-16	ID

General Provider Information

NPI Number	:	1659431088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY KENNETH DUCHOW CRNA

Provider Business Mailing Address
First Line	:	208 S KOOTENAI BAY RD
Second Line	:
City	:	SANDPOINT
State	:	ID
Zip	:	83864-8819
Country	:	US
Telephone Number	:	208-263-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 S KOOTENAI BAY RD
Second Line	:
City	:	SANDPOINT
State	:	ID
Zip	:	83864-8819
Country	:	US
Telephone Number	:	208-263-7874
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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