Provider Demographics
NPI:1881653517
Name:SALTER, MICHAEL G (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:SALTER
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 1660
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-0660
Mailing Address - Country:US
Mailing Address - Phone:515-628-2231
Mailing Address - Fax:816-461-6586
Practice Address - Street 1:404 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1291
Practice Address - Country:US
Practice Address - Phone:641-628-3150
Practice Address - Fax:816-461-6586
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062584367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2266338Medicaid
IAR83249Medicare UPIN
IA2266338Medicaid