MEDICARE: MARY MICHELE SUNSHINE 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	54545	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39865	OTHER		AANA CERTIFICATION

General Provider Information

NPI Number	:	1255312617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MICHELE SUNSHINE CRNA

Provider Business Mailing Address
First Line	:	13000 UNION RD
Second Line	:
City	:	MC LOUTH
State	:	KS
Zip	:	66054-5022
Country	:	US
Telephone Number	:	913-796-6221
Fax Number	:	913-796-6201

Provider Business Practice Location Address
First Line	:	505 POPE AVE
Second Line	:
City	:	FORT LEAVENWORTH
State	:	KS
Zip	:	66027-2333
Country	:	US
Telephone Number	:	913-684-6230
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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