Provider Demographics
NPI:1548251911
Name:MAUNU, KATHLEEN S (RN, CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:MAUNU
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MT HIGHWAY 91 S
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-7379
Mailing Address - Country:US
Mailing Address - Phone:406-683-3000
Mailing Address - Fax:406-683-3027
Practice Address - Street 1:600 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-7379
Practice Address - Country:US
Practice Address - Phone:406-683-3000
Practice Address - Fax:406-683-3027
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-139724-6367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN023644600Medicaid