=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770587628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN MARIE KAKAVAND CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1685 HOPKINS RD
-----------------------------------------------------
City | GETZVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14068-1164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-689-4315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1685 HOPKINS RD
-----------------------------------------------------
City | GETZVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14068-1164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-689-4315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN537172
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------