1255312617 NPI number — MARY MICHELE SUNSHINE CRNA

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	SUNSHINE
Provider First Name	:	MARY
Provider Middle Name	:	MICHELE
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	CRNA
Provider Gender Code	:	F

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NPI Number	:	1255312617
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
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Provider First Line Business Mailing Address	:	13000 UNION RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	MC LOUTH
Provider Business Mailing Address State Name	:	KS
Provider Business Mailing Address Postal Code	:	660545022
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	9137966221
Provider Business Mailing Address Fax Number	:	9137966201

Provider First Line Business Practice Location Address	:	505 POPE AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	FORT LEAVENWORTH
Provider Business Practice Location Address State Name	:	KS
Provider Business Practice Location Address Postal Code	:	660272333
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	9136846230
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/10/2005

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• Taxonomy code: 367500000X , with the licence number:  54545 , registered in the state of KS .

• Identifier: 39865 . This is a "AANA CERTIFICATION" identifier . This identifiers is of the category "".