Healthcare Provider Details

I. General information

NPI: 1598916025
Provider Name (Legal Business Name): KRISTIN D. BOUCHE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN D. HANSON CRNA

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANESTHESIA PRACTICE CONSULTANTS, PC 3333 EVERGREEN DR NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

48784 BEULAH WAY
MATTAWAN MI
49071-8877
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-4200
  • Fax: 616-364-7347
Mailing address:
  • Phone: 269-579-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704181397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: