Individual
MICHAEL SHANE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R850443
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06082519
—
MS
01
—
P01073766
RR MEDICARE
MS
Enumeration date
12/29/2006
Last updated
11/02/2017
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