MEDICARE: MR. MICHAEL JON KIRWAN 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	100955	NE

General Provider Information

NPI Number	:	1316931074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JON KIRWAN CRNA

Provider Business Mailing Address
First Line	:	20803 HEMLOCK ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-5119
Country	:	US
Telephone Number	:	402-380-0869
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 NORTH 22ND STREET
Second Line	:
City	:	BLAIR
State	:	NE
Zip	:	68008-1128
Country	:	US
Telephone Number	:	402-426-2182
Fax Number	:	402-426-1297

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	01/12/2022

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