Provider Demographics
NPI:1316931074
Name:KIRWAN, MICHAEL JON (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JON
Last Name:KIRWAN
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 1:20803 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5119
Mailing Address - Country:US
Mailing Address - Phone:402-380-0869
Mailing Address - Fax:
Practice Address - Street 1:810 NORTH 22ND STREET
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-2182
Practice Address - Fax:402-426-1297
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100955367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered