Provider Demographics
NPI:1528180791
Name:KIBURZ, CONNIE E (CRNA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:E
Last Name:KIBURZ
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 1:605 SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1958
Mailing Address - Country:US
Mailing Address - Phone:913-680-0812
Mailing Address - Fax:913-680-1445
Practice Address - Street 1:3310 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2111
Practice Address - Country:US
Practice Address - Phone:660-829-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00473637OtherRAILROAD MEDICARE
MO917714040Medicaid
MO26396046OtherBLUE CROSS BLUE SHIELD KANSAS CITY
KS17022OtherPREFERRED HEALTH SYSTEMS
MOW49000002Medicare PIN
MO26396046OtherBLUE CROSS BLUE SHIELD KANSAS CITY
MO430061881Medicare PIN
KS17022OtherPREFERRED HEALTH SYSTEMS