Individual
MICHAEL SCOTT FORTNER
Active
Individual
MICHAEL SCOTT FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R105201
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C002946
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871595512
WELLCARE - MEDICARE
AR
05
—
196069001
—
AR
01
—
4245152
BLUE CROSS BLUE SHIELD TENNESSEE
TN
01
—
P00820226
RR MEDICARE-PALMETTO GBA
TN
Enumeration date
08/12/2005
Last updated
12/02/2019
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