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General NPI Number Information
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NPI Number | 1215968961
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Entity Type | Individual
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Provider Name | THEODORE W BOGSRUD CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 16818 E DESMET CT
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-3542
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Country | US
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Telephone | 509-456-5380
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Fax | 509-456-5381
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Provider Business Mailing Address
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Address Line | 2517 NE KRESKY AVE
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City | CHEHALIS
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State | WA
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Zip | 98532-2409
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Country | US
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Telephone | 360-242-3008
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Fax | 360-807-7687
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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 | 28189
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License Number State | ID
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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 | NUR-RN-LIC-101109
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP30004818
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License Number State | WA
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