Provider Demographics
NPI:1952354466
Name:SAFRON, MICHELLE S (CRNA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:SAFRON
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 1:1025 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1248
Mailing Address - Country:US
Mailing Address - Phone:608-282-2050
Mailing Address - Fax:608-282-2058
Practice Address - Street 1:1025 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1248
Practice Address - Country:US
Practice Address - Phone:608-282-2050
Practice Address - Fax:608-282-2058
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156606367500000X
KS54499367500000X
MO118760367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1952354466Medicaid
WI44363300Medicaid
WI44363300Medicaid
WIP00388485Medicare PIN