Healthcare Provider Details

I. General information

NPI: 1659720126
Provider Name (Legal Business Name): KRYSTINA RENA DOOHEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTINA KINGHORN CRNA

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E 26TH ST
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

5403 S LEDGESTONE PL
SIOUX FALLS SD
57108-4514
US

V. Phone/Fax

Practice location:
  • Phone: 605-390-0790
  • Fax:
Mailing address:
  • Phone: 605-390-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000535
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR041095
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: