Provider Demographics
NPI:1912015496
Name:HANISCH, RICHARD KEITH (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEITH
Last Name:HANISCH
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 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 250E
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-838-6709
Mailing Address - Fax:509-835-4058
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:509-458-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006716367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8877206OtherMEDICARE TPAN
WA9641457Medicaid
Q17375Medicare UPIN
WA9641457Medicaid