Provider Demographics
NPI:1306393772
Name:DILLON KEHOE, KATHRYN DANIELLE (CRNA, MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DANIELLE
Last Name:DILLON KEHOE
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:DANIELLE
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 BROADVIEW ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3536
Mailing Address - Country:US
Mailing Address - Phone:989-928-1952
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered