Provider Demographics
NPI:1508976366
Name:SIUDA, JANET H (CRNA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:H
Last Name:SIUDA
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:PO BOX 413770
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-3770
Mailing Address - Country:US
Mailing Address - Phone:913-754-8508
Mailing Address - Fax:913-647-0575
Practice Address - Street 1:3840 W 75TH STREET
Practice Address - Street 2:PHYSICIANS SURGERY CENTER
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-384-9600
Practice Address - Fax:931-384-9646
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54736367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1002500606Medicaid
MO24743020OtherBLUE CROSS BLUE SHIELD
NEP00154159Medicare PIN
R30197Medicare UPIN
MOK158005AMedicare PIN
KSK158005BMedicare ID - Type Unspecified
KS1002500606Medicaid