MEDICARE: NINA ROHLING 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	390200000X	Student in an Organized Health Care Education/Training Program	201040519RN	OR
2	367500000X	Certified Registered Nurse Anesthetist	201360009CRNA	OR

General Provider Information

NPI Number	:	1649573247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA ROHLING CRNA

Provider Business Mailing Address
First Line	:	3505 SW MARQUAM HILL RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-1453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 HIGHWAY 71
Second Line	:	PO BOX AB
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1184
Country	:	US
Telephone Number	:	712-336-1230
Fax Number	:

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

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	05/08/2017

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