MEDICARE: MARY SCHLAUTMAN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	100908	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063581585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SCHLAUTMAN CRNA

Provider Business Mailing Address
First Line	:	2828 BROOKS HOLLOW DR
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-3681
Country	:	US
Telephone Number	:	402-720-8296
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 23RD ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-2302
Country	:	US
Telephone Number	:	402-727-7990
Fax Number	:	402-727-1761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/07/2022

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