Provider Demographics
NPI:1659357044
Name:SKRDLA-VAN DUSEN, LITHENA L (CRNA)
Entity Type:Individual
Prefix:
First Name:LITHENA
Middle Name:L
Last Name:SKRDLA-VAN DUSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LITHENA
Other - Middle Name:L
Other - Last Name:SKDRLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3254
Mailing Address - Country:US
Mailing Address - Phone:816-691-2021
Mailing Address - Fax:816-346-7690
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3254
Practice Address - Country:US
Practice Address - Phone:816-691-2021
Practice Address - Fax:816-346-7690
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100938367500000X
MO2007028642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE248478OtherMIDLANDS CHOICE
NE470653569-15Medicaid
NEP00299865OtherRR MEDICARE
P00612249OtherRAILROAD MEDICARE
NEP00299865OtherRR MEDICARE
P00612249OtherRAILROAD MEDICARE
NE279506Medicare ID - Type UnspecifiedCRNA