MEDICARE: MICHELLE DIANE LOWER 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	ARNP3269552	FL
2	367500000X	Certified Registered Nurse Anesthetist	28110239A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000718587	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215939616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DIANE LOWER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1329
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-1329
Country	:	US
Telephone Number	:	812-353-9816
Fax Number	:	812-275-1381

Provider Business Practice Location Address
First Line	:	2900 W 16TH STREET
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-275-1200
Fax Number	:	812-275-1231

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	02/06/2017

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Directions to “ MICHELLE DIANE LOWER CRNA” Practice Location

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