Provider Demographics
NPI:1649294836
Name:ZAHN, KEITH D (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:D
Last Name:ZAHN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:D
Other - Last Name:ZAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:4972 140TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-8604
Mailing Address - Country:US
Mailing Address - Phone:701-774-9706
Mailing Address - Fax:701-774-9705
Practice Address - Street 1:4972 140TH AVE NW
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-8604
Practice Address - Country:US
Practice Address - Phone:701-774-9706
Practice Address - Fax:070-177-4970
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR20952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered