MEDICARE: MRS. KIMBERLY SUE ZWEYGARDT 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	163W00000X	Registered Nurse	134470042	KS
2	367500000X	Certified Registered Nurse Anesthetist	54254	KS

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
2	101711	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1154352623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY SUE ZWEYGARDT CRNA

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-0347
Country	:	US
Telephone Number	:	785-332-2104
Fax Number	:	785-332-3255

Provider Business Practice Location Address
First Line	:	210 WEST 1ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-0347
Country	:	US
Telephone Number	:	785-332-2104
Fax Number	:	785-332-3255

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/03/2010

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