Provider Demographics
NPI:1912437005
Name:BIRD, MICHAELA DAWN (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:DAWN
Last Name:BIRD
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 1:2550 COUNTY ROAD 74
Mailing Address - Street 2:
Mailing Address - City:QUINTER
Mailing Address - State:KS
Mailing Address - Zip Code:67752-6116
Mailing Address - Country:US
Mailing Address - Phone:785-769-4091
Mailing Address - Fax:
Practice Address - Street 1:2220 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2370
Practice Address - Country:US
Practice Address - Phone:785-623-5096
Practice Address - Fax:785-623-5524
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC21099367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program