Provider Demographics
NPI:1639111529
Name:MADEJ, KATHLEEN MARIE (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MADEJ
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:4315 DIPLOMACY DR
Mailing Address - Street 2:ATTN: SHERRY REEDY
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-3971
Mailing Address - Fax:907-729-1542
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:ATTN: SHERRY REEDY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-3971
Practice Address - Fax:907-729-1542
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.028875367500000X
AK201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EZ31FMedicare ID - Type Unspecified
AKP56407Medicare UPIN