Healthcare Provider Details

I. General information

NPI: 1285029751
Provider Name (Legal Business Name): KATHERINE TEGTMEYER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE FOUT

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

PO BOX 460639
DENVER CO
80246-0639
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-7300
  • Fax:
Mailing address:
  • Phone: 303-349-5647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201501837
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0189385
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201501838
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: