Individual
MR. KEVIN BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE UHS-2, PORTLAND, OR 97239-3011
(503) 418-5019
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE UHS-2, PORTLAND, OR 97239-3011
(503) 418-5019
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
053057-23-11
NH
367500000X
Certified Registered Nurse Anesthetist
176907
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
201407790CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176494694
—
OR
Enumeration date
08/12/2006
Last updated
11/12/2024
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