Provider Demographics
NPI:1114901055
Name:DUTTWEILER-ESSER, SHARON A (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:A
Last Name:DUTTWEILER-ESSER
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 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 258
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1052850367500000X
IN28149226A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74347428Medicaid
INP00005483OtherRAILROAD MEDICARE
IN000000280766OtherANTHEM
000000288567OtherANTHEM BLUE SHIELD
IN200417460Medicaid
OH2380810Medicaid
KY74347428Medicaid
INCC1060JMedicare ID - Type Unspecified
430002967Medicare PIN
KY0094429Medicare ID - Type Unspecified