Provider Demographics
NPI:1659720126
Name:DOOHEN, KRYSTINA RENA (CRNA)
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:RENA
Last Name:DOOHEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRYSTINA
Other - Middle Name:
Other - Last Name:KINGHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5403 S LEDGESTONE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4514
Mailing Address - Country:US
Mailing Address - Phone:605-390-0790
Mailing Address - Fax:
Practice Address - Street 1:1100 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-390-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000535367500000X
SDR041095367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered