MEDICARE: WENDY LYNN MONRAD C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	15444	WY
2	163W00000X	Registered Nurse	22342	AK
3	163W00000X	Registered Nurse	674195	TX
4	367500000X	Certified Registered Nurse Anesthetist	250	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134186810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY LYNN MONRAD C.R.N.A.

Provider Business Mailing Address
First Line	:	4810 SOUTHPARK BLUFF DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-4845
Country	:	US
Telephone Number	:	907-360-7916
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 SOUTHPARK BLUFF DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-4845
Country	:	US
Telephone Number	:	907-360-7916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	10/23/2021

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