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NPI Code Detail

MEDICARE: MRS. JUDY LEE ROHL CRNA

MEDICARE: MRS. JUDY LEE ROHL 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 Anesthetist0024164987VA
2367500000XCertified Registered Nurse AnesthetistCRNA 2005MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2483983800OTHERMNMN HEALTH CARE PROVIDER

General Provider Information

NPI Number : 1467475889
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDY LEE ROHL CRNA
Provider Business Mailing Address
First Line : 35555 SPUR HWY # 188
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-7625
Country : US
Telephone Number : 907-953-9586
Fax Number :
Provider Business Practice Location Address
First Line : 250 HOSPITAL PL
Second Line :
City : SOLDOTNA
State : AK
Zip : 99669-6999
Country : US
Telephone Number : 907-714-4404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 10/08/2020

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