Healthcare Provider Details

I. General information

NPI: 1548251911
Provider Name (Legal Business Name): KATHLEEN S MAUNU RN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MT HIGHWAY 91 S
DILLON MT
59725-7379
US

IV. Provider business mailing address

600 MT HIGHWAY 91 S
DILLON MT
59725-7379
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-3000
  • Fax: 406-683-3027
Mailing address:
  • Phone: 406-683-3000
  • Fax: 406-683-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR-139724-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: