Provider Demographics
NPI:1023004959
Name:BONE, CARL G (CRNA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:BONE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-2853
Mailing Address - Country:US
Mailing Address - Phone:573-636-3483
Mailing Address - Fax:573-636-5315
Practice Address - Street 1:1445 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2853
Practice Address - Country:US
Practice Address - Phone:573-636-3483
Practice Address - Fax:573-636-5315
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118894367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered