MEDICARE: LORA GAIL CALONJE 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	RN115136	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	430065873	OTHER	AZ	RR MEDICARE
2	ZWCGCR	OTHER	AZ	GROUP MEDICARE NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1386616860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA GAIL CALONJE CRNA

Provider Business Mailing Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-7124
Country	:	US
Telephone Number	:	520-874-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1804
Country	:	US
Telephone Number	:	520-874-3500
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	10/23/2014

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