Healthcare Provider Details

I. General information

NPI: 1821309303
Provider Name (Legal Business Name): KRISTIN-MARIE ADOSHA GEFFEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN GUESS CRNA

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 N MOPAC EXPY STE 3-210
AUSTIN TX
78759-8862
US

IV. Provider business mailing address

8140 N MOPAC EXPY STE 3-210
AUSTIN TX
78759-8862
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-2292
  • Fax: 512-343-2745
Mailing address:
  • Phone: 512-343-2292
  • Fax: 512-343-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number681596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number66391
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number789993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: