Provider Demographics
NPI:1821228743
Name:MCDONALD, CHARLENE M (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:GARDNER TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0356
Mailing Address - Country:US
Mailing Address - Phone:800-374-5326
Mailing Address - Fax:800-374-7656
Practice Address - Street 1:720 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2112
Practice Address - Country:US
Practice Address - Phone:316-321-3300
Practice Address - Fax:630-792-5636
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1382074072163W00000X
KS140196367500000X
KS556929367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200634060AMedicaid
KS110017048Medicare PIN