Provider Demographics
NPI:1952304198
Name:ANDERSON, PAUL KURTIS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:KURTIS
Last Name:ANDERSON
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 1:7210 188TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2424
Mailing Address - Country:US
Mailing Address - Phone:253-210-3541
Mailing Address - Fax:
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156636367500000X
WAAP30006991367500000X
CO169824367500000X
MT31912367500000X
OR200560026CRNA367500000X
IDRNA-643367500000X
AK278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00390773OtherRAILROAD MEDICARE
WAP00249398OtherRAILROAD MEDICARE
MTP00349024OtherRAILROAD MEDICARE
ORR134063Medicare PIN
WAG8858799Medicare PIN
MT000006659Medicare PIN
WAG8855930Medicare PIN
AKK160599Medicare PIN
WAG8855931Medicare PIN
WAG8855927Medicare PIN
WAP00390773OtherRAILROAD MEDICARE
WAP00249398OtherRAILROAD MEDICARE
ID1604634Medicare PIN