Basic Information
| Provider Information | |||||||||
| NPI: | 1912437005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRD | ||||||||
| FirstName: | MICHAELA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 COUNTY ROAD 74 | ||||||||
| Address2: | |||||||||
| City: | QUINTER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677526116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857694091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2220 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856235096 | ||||||||
| FaxNumber: | 7856235524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 21099 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.