Basic Information
| Provider Information | |||||||||
| NPI: | 1811001597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENGLER | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7822 DAVENPORT STREET | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023914855 | ||||||||
| FaxNumber: | 4023916818 | ||||||||
| Practice Location | |||||||||
| Address1: | 8303 DODGE STREET | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023544000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 100518 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.