Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
084548
MO
367500000X
Certified Registered Nurse Anesthetist
209-001689
IL
367500000X
Certified Registered Nurse Anesthetist
4704131876
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
917422107
—
MO
Enumeration date
—
Last updated
—
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