Healthcare Provider Details

I. General information

NPI: 1821239922
Provider Name (Legal Business Name): PEGAH VAHDAT HARLAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGAH DAHER CRNA

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 W THREEWOOD CT
ANDOVER KS
67002-4401
US

IV. Provider business mailing address

945 W THREEWOOD CT
ANDOVER KS
67002-4401
US

V. Phone/Fax

Practice location:
  • Phone: 515-339-6994
  • Fax:
Mailing address:
  • Phone: 515-339-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557133-031
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number114627
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: