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NPI Code Detail

MEDICARE: MICHAEL D WESLEY CRNA

MEDICARE: MICHAEL D WESLEY 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
1367500000XCertified Registered Nurse AnesthetistRN216636OH
2367500000XCertified Registered Nurse AnesthetistRN-216636OH
3367500000XCertified Registered Nurse AnesthetistAPRN11001417FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306861901
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D WESLEY CRNA
Provider Business Mailing Address
First Line : 4101 EVANS AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9310
Country : US
Telephone Number : 239-939-3456
Fax Number :
Provider Business Practice Location Address
First Line : 4101 EVANS AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9310
Country : US
Telephone Number : 239-939-3456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 03/04/2019

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