Healthcare Provider Details

I. General information

NPI: 1164518726
Provider Name (Legal Business Name): JEAN E HOKANA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N MAIN STREET
SPEARFISH SD
57783-1505
US

IV. Provider business mailing address

353 FAIRMONT BLVD ATTEN MEDICAL STAFF SERVICES
RAPID CITY SD
57701-5000
US

V. Phone/Fax

Practice location:
  • Phone: 605-347-2536
  • Fax:
Mailing address:
  • Phone: 605-719-7109
  • Fax: 605-719-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR022214
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000203
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: