Healthcare Provider Details

I. General information

NPI: 1043591001
Provider Name (Legal Business Name): REBECCA RENE' BOUST CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

IV. Provider business mailing address

810 RAVENHILL DR
ATCHISON KS
66002-9204
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-5360
  • Fax: 913-674-2013
Mailing address:
  • Phone: 913-367-5360
  • Fax: 913-674-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60246708
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: