Basic Information
| Provider Information | |||||||||
| NPI: | 1831280221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOHLER | ||||||||
| FirstName: | SHAUNA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1780 | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826331780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073585590 | ||||||||
| FaxNumber: | 3073585590 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 5TH STREET | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00066514 | 01 | RAILROAD MC | OTHER | 312025 | 01 | WY | BCBS | OTHER |