Basic Information
| Provider Information | |||||||||
| NPI: | 1154429264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KILBOURNE | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | LOIUSE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S DOBSON RD | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807866655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2563 S VAL VISTA DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852951804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807866655 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CRNA0527 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | R0020732 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.