MEDICARE: MR. CONOR T MULCAHY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	43-557077-112	KS

General Provider Information

NPI Number	:	1295096709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONOR T MULCAHY CRNA

Provider Business Mailing Address
First Line	:	7811 BIRCH ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208
Country	:	US
Telephone Number	:	913-406-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	7811 BIRCH ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-4747
Country	:	US
Telephone Number	:	913-406-1166
Fax Number	:

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

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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