Individual
THEODORE W BOGSRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
16818 E DESMET CT, SPOKANE VALLEY, WA 99216-3542
(509) 456-5380
(509) 456-5381
Mailing address
2517 NE KRESKY AVE, CHEHALIS, WA 98532-2409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28189
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30004818
WA
367500000X
Certified Registered Nurse Anesthetist
NUR-RN-LIC-101109
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1204355
MEDICARE ID
ID
01
—
430044217
RAILROAD MEDICARE
WA
01
—
430048398
RAILROAD MEDICARE
WA
01
—
430061770
RAILROAD MEDICARE
WA
01
—
430062516
RAILROAD MEDICARE
ID
05
—
9630542
—
WA
01
—
M011002649
MEDICARE MT
MT
01
—
NM302933
MEDICARE NM
NM
01
—
P00335315
RAILROAD MEDICARE
MT
Enumeration date
07/05/2006
Last updated
11/18/2020
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