Healthcare Provider Details

I. General information

NPI: 1740283456
Provider Name (Legal Business Name): DAVID C BOHARSKI CRNA, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 9TH ST S
GREAT FALLS MT
59405-4503
US

IV. Provider business mailing address

PO BOX 8654
KALISPELL MT
59904-1654
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax:
Mailing address:
  • Phone: 406-270-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN24307
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24307
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: