MEDICARE: MR. LADD SHANER C.R.N.A.

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	APRN.CRNA.02531	OH
2	367500000X	Certified Registered Nurse Anesthetist	201805701CRNA-PP	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1497747745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LADD SHANER C.R.N.A.

Provider Business Mailing Address
First Line	:	8766 GALLOWAY TRL
Second Line	:
City	:	NOVELTY
State	:	OH
Zip	:	44072-9653
Country	:	US
Telephone Number	:	440-338-6955
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 W WASHINGTON ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720
Country	:	US
Telephone Number	:	541-573-7281
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	11/19/2018

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