Provider Demographics
NPI:1093710725
Name:MCHALE-SASS, ANN M (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:MCHALE-SASS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:65W1 DIVISION AVE.
Practice Address - Street 2:PMB 114
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2485
Practice Address - Country:US
Practice Address - Phone:541-689-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078040532CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136452Medicaid
ORR01259Medicare UPIN
ORR118166Medicare PIN
OR136452Medicaid