Provider Demographics
NPI:1710999594
Name:BIALY, MICHELE LOUISE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LOUISE
Last Name:BIALY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LOUISE
Other - Last Name:LOFFREDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:465 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-784-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051207367500000X
CANA3311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA0033110OtherBLUE SHIELD OF CA
CAZZZ04749ZMedicare PIN