Provider Demographics
NPI:1275662744
Name:JANSKY, KATHRYN L (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:JANSKY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9283 KORNBRUST DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5334
Mailing Address - Country:US
Mailing Address - Phone:720-502-3650
Mailing Address - Fax:
Practice Address - Street 1:9283 KORNBRUST DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5334
Practice Address - Country:US
Practice Address - Phone:720-502-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00097290163W00000X
WAAP30004987367500000X
CORN.0098735163W00000X
COAPN.0990716-CRNA163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9620378Medicaid
WAG8872393Medicare PIN
WA9620378Medicaid
WAGAB08134Medicare PIN