Provider Demographics
NPI:1750561650
Name:BOMBARDIER, ANNE MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:BOMBARDIER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:MOECKLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2099
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4560
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2099
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183804367500000X
OR201701964CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered