Healthcare Provider Details

I. General information

NPI: 1861932527
Provider Name (Legal Business Name): KATHRINE WATADA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRINE BOSCH CRNA

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

IV. Provider business mailing address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84009
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101406
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: