MEDICARE: MS. KATHLEEN R ANDERSON CRNA

Medicare Provider Information

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	1159-033	WI
2	367500000X	Certified Registered Nurse Anesthetist	108968-030	WI
3	367500000X	Certified Registered Nurse Anesthetist	55137	KS

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00245174	OTHER	KS	RR MEDICARE GROUP CQ2303

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

NPI Number	:	1881602456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN R ANDERSON CRNA

Provider Business Mailing Address
First Line	:	5255 MEMPHIS ST UNIT 107
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5228
Country	:	US
Telephone Number	:	303-506-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 MEMPHIS ST UNIT 107
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-5228
Country	:	US
Telephone Number	:	303-506-6995
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/31/2009

1491 N DENVER AVE STE 101
LOVELAND, CO
80538-5228

Practice Phone: 970-663-2225
Practice Fax: 970-539-6748