Healthcare Provider Details

I. General information

NPI: 1356711006
Provider Name (Legal Business Name): MICHELLE BLOEDEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E 11TH AVE
WINFIELD KS
67156-3716
US

IV. Provider business mailing address

709 E 11TH AVE
WINFIELD KS
67156-3716
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-6182
  • Fax:
Mailing address:
  • Phone: 620-221-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557369
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: