Provider Demographics
NPI:1477948628
Name:KUNUGIYAMA, SUJEN KAYLEE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUJEN
Middle Name:KAYLEE
Last Name:KUNUGIYAMA
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 1:500 NE MULTNOMAH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2023
Mailing Address - Country:US
Mailing Address - Phone:503-813-3860
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2023
Practice Address - Country:US
Practice Address - Phone:503-813-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-91351163W00000X
WARN60306187163W00000X
OR200541558RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse