MEDICARE: LAURINDA WADE 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	54322	KS

General Provider Information

NPI Number	:	1538137393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURINDA WADE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1148
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67201-1148
Country	:	US
Telephone Number	:	316-685-3698
Fax Number	:	316-652-0340

Provider Business Practice Location Address
First Line	:	10014 W GREENSPOINT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1581
Country	:	US
Telephone Number	:	316-946-5980
Fax Number	:	316-652-0340

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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