MEDICARE: DALE L ROBERTSON 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	43-54349-022	KS
2	367500000X	Certified Registered Nurse Anesthetist	114823	MO

General Provider Information

NPI Number	:	1376512996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE L ROBERTSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 411851
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-1851
Country	:	US
Telephone Number	:	913-588-6670
Fax Number	:	913-588-3365

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 1034
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:	913-588-6670
Fax Number	:	913-588-3365

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/29/2014

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