Provider Demographics
NPI: | 1700851144 |
---|---|
Name: | STRAWN, DAVID M (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | DAVID |
Middle Name: | M |
Last Name: | STRAWN |
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: | PO BOX 3276 |
Mailing Address - Street 2: | |
Mailing Address - City: | EVANSVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47731-3276 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-473-0181 |
Mailing Address - Fax: | 812-473-5822 |
Practice Address - Street 1: | 1305 N ELM ST |
Practice Address - Street 2: | ANESTHESIA DEPARTMENT |
Practice Address - City: | HENDERSON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42420-2783 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-827-7700 |
Practice Address - Fax: | 270-827-7469 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-02-21 |
Last Update Date: | 2012-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 1036784 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 74337916 | Medicaid | |
KY | 000000337068 | Other | ANTHEM BC & BS |
430073721 | Medicare ID - Type Unspecified | RR MEDICARE | |
KY | 74337916 | Medicaid |