Organization
KIM HACKL ANESTHESIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM HACKL CRNA (PRESIDENT)
(406) 586-0802
Entity
Organization
Contact information
Practice address
300 N WILLSON AVE, BOZEMAN, MT 59715-3551
(406) 586-1956
Mailing address
3720 TRAIL CREEK RD, BOZEMAN, MT 59715-1719
(406) 586-0802
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN20815
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4308106
—
MT
Enumeration date
11/14/2006
Last updated
08/22/2020
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