MEDICARE: MAURA SHERIDAN-WALTHER 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	L60A00035	DE

General Provider Information

NPI Number	:	1255361358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA SHERIDAN-WALTHER CRNA

Provider Business Mailing Address
First Line	:	255 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49204-1123
Country	:	US
Telephone Number	:	517-787-6440
Fax Number	:	517-787-4146

Provider Business Practice Location Address
First Line	:	2 READ'S WAY
Second Line	:	SUITE 201
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-1507
Country	:	US
Telephone Number	:	302-709-4706
Fax Number	:	302-709-4551

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/04/2011

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