Provider Demographics
NPI:1457387391
Name:MYERS, MICHAEL R (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MYERS
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 1:14914 67TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-9206
Mailing Address - Country:US
Mailing Address - Phone:701-352-3604
Mailing Address - Fax:701-352-3604
Practice Address - Street 1:14914 67TH ST NE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-9206
Practice Address - Country:US
Practice Address - Phone:701-352-3604
Practice Address - Fax:701-352-3604
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR121975-1367500000X
NDR19657367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND200189OtherLHS/BANNERHEALTH #
MN86D19MYOtherMNBS #
MN937254OtherAMERICA'S PPO/ARAZ #
MN952526200Medicaid
MNDAP021026986OtherPREFERRED ONE #
MNHP38638OtherHEALTHPARTNERS #
MN169230OtherUCARE #
MN19063OtherNDBS #
MN2000780OtherMEDICA #
MN2000780OtherMEDICA #
MN952526200Medicaid
MN430003102Medicare ID - Type UnspecifiedMN MEDICARE #