Provider Demographics
NPI:1427061530
Name:WERNER, SHIRLEY A (CRNA)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:A
Last Name:WERNER
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:PO BOX 643179
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3179
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:
Practice Address - Street 1:600 WILSON CREEK ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:812-926-3209
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28045383A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000244196OtherANTHEM
OH2479081Medicaid
OH2479081Medicaid