Provider Demographics
NPI:1255060687
Name:MUTTAI, JOSHUA (CRNA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MUTTAI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4916 WOODSONIA DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3831
Mailing Address - Country:US
Mailing Address - Phone:913-710-2909
Mailing Address - Fax:
Practice Address - Street 1:823 SW MULVANE ST STE 210
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1679
Practice Address - Country:US
Practice Address - Phone:785-235-3451
Practice Address - Fax:785-235-1435
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS99751163WC0200X
KS43-558040-102207L00000X
KS43558040102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS43-558040-102OtherCRNA