Provider Demographics
NPI:1083888424
Name:KALIL, ADRIAN LESLIE (CRNA CERTIFIFED REGI)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:LESLIE
Last Name:KALIL
Suffix:
Gender:M
Credentials:CRNA CERTIFIFED REGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 BLANKENSHIP ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068
Mailing Address - Country:US
Mailing Address - Phone:503-655-3851
Mailing Address - Fax:503-655-3318
Practice Address - Street 1:1830 BLANKENSHIP ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:503-655-3851
Practice Address - Fax:503-655-3318
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered