MEDICARE: ANN MARIE KAKAVAND 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	RN537172	PA

General Provider Information

NPI Number	:	1770587628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE KAKAVAND CRNA

Provider Business Mailing Address
First Line	:	1685 HOPKINS RD
Second Line	:
City	:	GETZVILLE
State	:	NY
Zip	:	14068-1164
Country	:	US
Telephone Number	:	716-689-4315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1685 HOPKINS RD
Second Line	:
City	:	GETZVILLE
State	:	NY
Zip	:	14068-1164
Country	:	US
Telephone Number	:	716-689-4315
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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