Healthcare Provider Details

I. General information

NPI: 1295369494
Provider Name (Legal Business Name): JANA BIEBERLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 855-429-7633
  • Fax:
Mailing address:
  • Phone: 785-623-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557757
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: