MEDICARE: MR. MICHAEL CRAIG ERBERT R.N.

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	163W00000X	Registered Nurse	138687	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138687	OTHER	MO	NURSING LICENSE

General Provider Information

NPI Number	:	1760615611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CRAIG ERBERT R.N.

Provider Business Mailing Address
First Line	:	625 N OAK ST
Second Line	:
City	:	GARDNER
State	:	KS
Zip	:	66030-1772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15431 ANDREWS RD
Second Line	:	BLDG 601
City	:	KANSAS CITY
State	:	MO
Zip	:	64147-1221
Country	:	US
Telephone Number	:	816-843-3666
Fax Number	:

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

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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