Provider Demographics
NPI:1457674640
Name:BURMAN, KEVIN P (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:BURMAN
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1439
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVENUE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN619028367500000X
ID46909367500000X
MTNUR-RN-LIC-71934367500000X
OR201394417CRNA367500000X
NMCRNA-0182367500000X
AKNURA428367500000X
WAAP60140049367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20004631OtherMEDICARE ID
OR500670615Medicaid
WAG8923257OtherMEDICARE WA
WAG8926234OtherMEDICARE WA
MTM011004119OtherMEDICARE MT
ID1457674640Medicaid
WA2005970Medicaid
NM324226YWN7OtherMEDICARE NM
ORR174152OtherMEDICARE OR
CRNA082826OtherNATIONAL CRNA CERTIFICATION
AKK165387OtherMEDICARE AK