Healthcare Provider Details

I. General information

NPI: 1548409709
Provider Name (Legal Business Name): KATHRYN COLLEEN DEWILDE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY COLLEEN GOULD CRNA

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE ANESTHESIOLOGY DEPT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE ANESTHESIOLOGY DEPT
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3780
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN652433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: