Provider Demographics
NPI:1063480374
Name:BAUERNFEIND, TODD W (CRNA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:BAUERNFEIND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2756
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00126402367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4303897Medicaid
WA8938960OtherCRIME VICTIMS
WA9623166Medicaid
ID000010147512OtherREGENCE BLUE SHIELD OF ID
WAP00130913OtherRR MEDICARE
WA28402OtherGROUP HEALTH NW
WA9544BAOtherASURIS NW HEALTH
WA0185165OtherDEPT OF LABOR & INDUSTRIE
WA8938960OtherCRIME VICTIMS
WA9623166Medicaid