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NPI Code Detail

MEDICARE: MARY L MUENCH CRNA

MEDICARE: MARY L MUENCH 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
1163W00000XRegistered NurseRN00084325WA
2367500000XCertified Registered Nurse AnesthetistAP30004075WA
3163W00000XRegistered Nurse18343ID
4367500000XCertified Registered Nurse AnesthetistRNA-45AID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649361007
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L MUENCH CRNA
Provider Business Mailing Address
First Line : PO BOX 423
Second Line :
City : GRANGEVILLE
State : ID
Zip : 83530
Country : US
Telephone Number : 208-413-8744
Fax Number : 208-983-1921
Provider Business Practice Location Address
First Line : 500 PORT DR
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-1835
Country : US
Telephone Number : 509-758-8811
Fax Number : 509-751-1188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 04/13/2017

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