Healthcare Provider Details

I. General information

NPI: 1730260985
Provider Name (Legal Business Name): MICHAEL GEORGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N COLUMBIA AVE
SEWARD NE
68434-2228
US

IV. Provider business mailing address

1440 208TH DR
SEWARD NE
68434-8109
US

V. Phone/Fax

Practice location:
  • Phone: 402-643-2971
  • Fax: 402-646-4654
Mailing address:
  • Phone: 402-643-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22970/100040
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: