Provider Demographics
NPI:1861822116
Name:LOUDNER, MICHAEL LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:LOUDNER
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 1:6385 ELECTRIC RAILWAY
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8684
Mailing Address - Country:US
Mailing Address - Phone:315-450-1784
Mailing Address - Fax:
Practice Address - Street 1:4842 BROAD RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-492-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY535456163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse