Provider Demographics
NPI:1982640447
Name:FUEMMELER, REIDUN S (CRNA)
Entity Type:Individual
Prefix:
First Name:REIDUN
Middle Name:S
Last Name:FUEMMELER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REIDUN
Other - Middle Name:S
Other - Last Name:RUXLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8717 W 110TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2126
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:17065 S OUTER RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:816-348-1200
Practice Address - Fax:913-428-2951
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO147423367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO671645OtherHEALTHLINK
MO127254OtherBLUE SHIELD/BLUE CHOICE
MO2003193OtherUNITED HEALTHCARE
MO919166405Medicaid