Provider Demographics
NPI:1114190162
Name:BIERBAUM, ADAM J (CRNA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:BIERBAUM
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:PO BOX 34310
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0310
Mailing Address - Country:US
Mailing Address - Phone:402-778-9738
Mailing Address - Fax:402-334-2849
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-778-9738
Practice Address - Fax:402-334-2849
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101030367500000X
IAD115455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE101030OtherNE LICENSE
NE10025745800Medicaid
NENA1324OtherMEDICARE-MIDLANDS
NE10025507900Medicaid
NE098713OtherMEDICARE-IMC/BERGAN
NE10025709800Medicaid
NE098713OtherMEDICARE
NE47055043815Medicaid
IAI21224OtherMEDICARE-MERCY