Provider Demographics
NPI:1659431088
Name:DUCHOW, KAY KENNETH (CRNA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:KENNETH
Last Name:DUCHOW
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 1:208 S KOOTENAI BAY RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8819
Mailing Address - Country:US
Mailing Address - Phone:208-263-7874
Mailing Address - Fax:
Practice Address - Street 1:208 S KOOTENAI BAY RD
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8819
Practice Address - Country:US
Practice Address - Phone:208-263-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-16367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered