Individual
KEVIN JAMES MALTAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
568 RUIN CREEK RD, SUITE 105, HENDERSON, NC 27536-2880
(252) 436-1380
(252) 436-1851
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024167055
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
181612
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051607
—
NC
Enumeration date
10/05/2006
Last updated
04/28/2008
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