Provider Demographics
NPI:1154429264
Name:KILBOURNE, EVA LOIUSE (CRNA)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:LOIUSE
Last Name:KILBOURNE
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 1:600 S DOBSON RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-786-6655
Mailing Address - Fax:
Practice Address - Street 1:2563 S VAL VISTA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1804
Practice Address - Country:US
Practice Address - Phone:480-786-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0527367500000X
OKR0020732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ157825,Z133860Medicare UPIN