MEDICARE: DAVID C BOHARSKI CRNA, FNP

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	363LF0000X	Family Nurse Practitioner	RN24307	MT
2	367500000X	Certified Registered Nurse Anesthetist	24307	MT

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	:	1740283456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C BOHARSKI CRNA, FNP

Provider Business Mailing Address
First Line	:	PO BOX 8654
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59904-1654
Country	:	US
Telephone Number	:	406-270-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 9TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4503
Country	:	US
Telephone Number	:	406-454-2171
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/23/2009

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