Provider Demographics
NPI:1891748406
Name:BURDETT, RUTH ANN (CRNA)
Entity type:Individual
Prefix:
First Name:RUTH ANN
Middle Name:
Last Name:BURDETT
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 1:2921 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2130
Mailing Address - Country:US
Mailing Address - Phone:913-384-5290
Mailing Address - Fax:
Practice Address - Street 1:2921 W 68TH ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:KS
Practice Address - Zip Code:66208-2130
Practice Address - Country:US
Practice Address - Phone:913-384-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54672367500000X
MO88335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS21016011OtherKS BCBS NUMBER
MO21016031OtherMO BCBS NUMBER
KS21016011OtherKS BCBS NUMBER
MO21016031OtherMO BCBS NUMBER