MEDICARE: BARBARA S KLUBE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00046787	WA
2	163W00000X	Registered Nurse	AP30005268	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235134693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA S KLUBE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 97115
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98497-0115
Country	:	US
Telephone Number	:	253-588-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 26TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3013
Country	:	US
Telephone Number	:	206-720-1597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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