Provider Demographics
NPI:1619203072
Name:KAISER, JACQUELINE RACHELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RACHELLE
Last Name:KAISER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:RACHELLE
Other - Last Name:KOSLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7610 SANTIAGO RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7237
Mailing Address - Country:US
Mailing Address - Phone:505-238-3900
Mailing Address - Fax:505-200-2954
Practice Address - Street 1:7788 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4342
Practice Address - Country:US
Practice Address - Phone:505-999-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01067367500000X
NMR51858367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered