Provider Demographics
NPI:1093822637
Name:BERKBIGLER, WAYNE E (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:E
Last Name:BERKBIGLER
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 1:1724 HILL HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-4833
Mailing Address - Country:US
Mailing Address - Phone:417-336-3662
Mailing Address - Fax:417-334-7529
Practice Address - Street 1:915 STATE HIGHWAY 248
Practice Address - Street 2:SUITE B
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8003
Practice Address - Country:US
Practice Address - Phone:417-335-8572
Practice Address - Fax:417-335-8573
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO049094367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered