Basic Information
| Provider Information | |||||||||
| NPI: | 1487957601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WORLD WIDE ANESTHESIA ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 254 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205842002 | ||||||||
| FaxNumber: | 6205842242 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MAIN | ||||||||
| Address2: | CIMARRON HEALTHCARE CENTER | ||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 12/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | GERBERDING | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6205842002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 077539 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.