Individual
KATHRYN CLARK DEARBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2233 STATE ROUTE 86, SARANAC LAKE, NY 12983-5644
(581) 891-4141
(404) 941-1282
Mailing address
1236 E ELIZABETH ST, SUITE 1, FORT COLLINS, CO 80524-4000
(970) 224-2985
(970) 472-9381
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
615852-1
NY
367500000X
Certified Registered Nurse Anesthetist
CRA-100084
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80574823
—
CO
01
—
COAAA4235
CO MEDICARE
CO
01
—
P01080610
MEDICARE RAILROAD
CO
Enumeration date
10/18/2011
Last updated
05/19/2023
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