Provider Demographics
NPI:1982636536
Name:GRESS, CYNTHIA DIANE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:GRESS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 3RD AVE
Mailing Address - Street 2:PO BOX 0488
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3601
Mailing Address - Country:US
Mailing Address - Phone:812-482-9617
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:602 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3601
Practice Address - Country:US
Practice Address - Phone:812-482-9617
Practice Address - Fax:812-634-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28080901A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCB2060DOtherDAVIESS COUNTY HOSPITAL MEDICARE PROVIDER #
IN1215015771OtherGRESS ANESTHESIA SERVICES GROUP NPI #
INP00116059OtherDAVIESS COUNTY HOSPITAL MEDICARE R/R PROVIDER #
IN200055770OtherDAVIESS COUNTY HOSPITAL MEDICAID PROVIDER #
IN200055770Medicaid
INR20636Medicare UPIN
INCB2060DOtherDAVIESS COUNTY HOSPITAL MEDICARE PROVIDER #