Provider Demographics
NPI:1568885424
Name:MADDEN, KRISTA (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:LAUERHASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21040
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7197
Mailing Address - Country:US
Mailing Address - Phone:509-473-7672
Mailing Address - Fax:
Practice Address - Street 1:800 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2803
Practice Address - Country:US
Practice Address - Phone:509-473-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT100711367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered