Basic Information
| Provider Information | |||||||||
| NPI: | 1063480374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUERNFEIND | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093442663 | ||||||||
| FaxNumber: | 5096249179 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093442663 | ||||||||
| FaxNumber: | 5096249179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN00126402 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 4303897 | 05 | MT | MEDICAID | 8938960 | 01 | WA | CRIME VICTIMS | OTHER | 9623166 | 05 | WA | MEDICAID | 000010147512 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | P00130913 | 01 | WA | RR MEDICARE | OTHER | 28402 | 01 | WA | GROUP HEALTH NW | OTHER | 9544BA | 01 | WA | ASURIS NW HEALTH | OTHER | 0185165 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER |