MEDICARE: SUSAN DIANE THOMAS 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	100567	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38159	OTHER	NE	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	27005	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1891763637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DIANE THOMAS CRNA

Provider Business Mailing Address
First Line	:	72922 642 AVE
Second Line	:
City	:	AUBURN
State	:	NE
Zip	:	68305-8205
Country	:	US
Telephone Number	:	402-274-7238
Fax Number	:	402-274-4920

Provider Business Practice Location Address
First Line	:	72922 642 AVE
Second Line	:
City	:	AUBURN
State	:	NE
Zip	:	68305-8205
Country	:	US
Telephone Number	:	402-274-7238
Fax Number	:	402-274-4920

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/07/2008

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Directions to “ SUSAN DIANE THOMAS CRNA” Practice Location

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