Healthcare Provider Details

I. General information

NPI: 1508976366
Provider Name (Legal Business Name): JANET H SIUDA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 W 75TH STREET PHYSICIANS SURGERY CENTER
PRAIRIE VILLAGE KS
66208
US

IV. Provider business mailing address

PO BOX 413770
KANSAS CITY MO
64141-3770
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-9600
  • Fax: 931-384-9646
Mailing address:
  • Phone: 913-754-8508
  • Fax: 913-647-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54736
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: