MEDICARE: JUDITH A BOTTGER CRNA

Medicare Provider Information

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	D042389	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	33480	OTHER	IA	BLUE CROSS OF IA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	R013639	OTHER		DAKOTACARE
6	0040726	OTHER	SD	BLUE CROSS OF SD
7	08652	OTHER	NE	BLUE CROSS OF NE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7511	OTHER		AVERA HEALTH PLANS

NPI Number	:	1720088446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A BOTTGER CRNA

Provider Business Mailing Address
First Line	:	400 E 10TH ST
Second Line	:
City	:	WACONIA
State	:	MN
Zip	:	55387-4552
Country	:	US
Telephone Number	:	952-442-9770
Fax Number	:	952-442-3620

Provider Business Practice Location Address
First Line	:	4405 HAMILTON BLVD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1140
Country	:	US
Telephone Number	:	712-239-3937
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/28/2008

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

4405 HAMILTON BLVD
SIOUX CITY, IA
51104-1140