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General NPI Number Information
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NPI Number | 1124112842
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Entity Type | Individual
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Provider Name | CRAIG G KLEIV CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 6400 SE LAKE RD STE 300
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City | PORTLAND
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State | OR
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Zip | 97222-2129
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Country | US
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Telephone | 503-594-1774
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22617
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City | PORTLAND
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State | OR
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Zip | 97269-2617
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Country | US
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Telephone | 850-582-2985
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Fax |
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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 | OR200360015CRNA
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN3195402
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License Number State | FL
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