Basic Information
| Provider Information | |||||||||
| NPI: | 1932381910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREATIVE ANESTHESIA SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3404 | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834033404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085252090 | ||||||||
| FaxNumber: | 2085238978 | ||||||||
| Practice Location | |||||||||
| Address1: | 1414 N HOUK RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VLY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992161097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099288040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | KRAUS-SCHAEFFER | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5098566874 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP30006232 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.