Provider Demographics
NPI:1275729774
Name:LEVINE, KATHRYN E (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:LEVINE
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 1:638 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1887
Mailing Address - Country:US
Mailing Address - Phone:541-482-1691
Mailing Address - Fax:541-482-1777
Practice Address - Street 1:638 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1887
Practice Address - Country:US
Practice Address - Phone:541-482-1691
Practice Address - Fax:541-482-1777
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331504367500000X
OR090006575CR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031158Medicaid
MA110151442AMedicaid
WI1275729774Medicaid