Healthcare Provider Details

I. General information

NPI: 1326331109
Provider Name (Legal Business Name): NATHAN SCOTT SHURDEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SW MULVANE SUITE 210
TOPEKA KS
66606-1679
US

IV. Provider business mailing address

4100 W 24TH PL APT A9
LAWRENCE KS
66047-2351
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-3451
  • Fax:
Mailing address:
  • Phone: 785-424-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number114793
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-113628
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: