Provider Demographics
NPI:1255312617
Name:SUNSHINE, MARY MICHELE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELE
Last Name:SUNSHINE
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 1:13000 UNION RD
Mailing Address - Street 2:
Mailing Address - City:MC LOUTH
Mailing Address - State:KS
Mailing Address - Zip Code:66054-5022
Mailing Address - Country:US
Mailing Address - Phone:913-796-6221
Mailing Address - Fax:913-796-6201
Practice Address - Street 1:505 POPE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2333
Practice Address - Country:US
Practice Address - Phone:913-684-6230
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54545367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
39865OtherAANA CERTIFICATION