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General NPI Number Information
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NPI Number | 1003874629
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Entity Type | Individual
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Provider Name | CHARLES KENNETH LEONARD CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1016 TACOMA AVE SUNNYSIDE COMMUNITY HOSPITAL
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2263
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Country | US
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Telephone | 509-837-1500
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Fax | 509-837-1584
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | MABTON
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State | WA
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Zip | 98935
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Country | US
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Telephone | 509-894-5559
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Fax | 309-403-8642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 38956
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License Number State | WA
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