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NPI Code Detail

MEDICARE: MICHELE IDERA CRNA

MEDICARE: MICHELE IDERA 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 AnesthetistNA2932CA
2367500000XCertified Registered Nurse AnesthetistCRNA1498AZ

Other Identifiers

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

General Provider Information

NPI Number : 1639154537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE IDERA CRNA
Provider Business Mailing Address
First Line : PO BOX 7096
Second Line :
City : STOCKTON
State : CA
Zip : 95267-0096
Country : US
Telephone Number : 209-956-7725
Fax Number : 209-956-7733
Provider Business Practice Location Address
First Line : 1551 E TANGERINE RD
Second Line :
City : ORO VALLEY
State : AZ
Zip : 85755-6213
Country : US
Telephone Number : 520-901-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 04/17/2025

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