Provider Demographics
NPI:1053361980
Name:DONCOUSE, KAREN (CRNA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DONCOUSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9696 W HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-7232
Mailing Address - Country:US
Mailing Address - Phone:208-221-5153
Mailing Address - Fax:
Practice Address - Street 1:1950 E CLARK ST
Practice Address - Street 2:SUITE G
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3314
Practice Address - Country:US
Practice Address - Phone:208-232-7760
Practice Address - Fax:208-232-1950
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA390163W00000X
IDRNA-390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805086500Medicaid
ID1602500Medicare ID - Type Unspecified