Provider Demographics
NPI:1487648549
Name:FLOWERDAY, ROBERT STEVEN (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:FLOWERDAY
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 1:2467 WILLOW LOOP
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-7714
Mailing Address - Country:US
Mailing Address - Phone:541-902-3178
Mailing Address - Fax:
Practice Address - Street 1:2467 WILLOW LOOP
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7714
Practice Address - Country:US
Practice Address - Phone:541-902-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1069979163W00000X
IN28143365A163W00000X
KY1683A367500000X
OR077038605RN163W00000X
OR200360056CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200253960Medicaid
INR38353Medicare UPIN
INCB9180Medicare ID - Type Unspecified