Basic Information
| Provider Information | |||||||||
| NPI: | 1295149235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHADBURN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 S 30TH AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S 30TH AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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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 | 9303569 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | AP60506972 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.