Provider Demographics
NPI:1255365318
Name:WAMEGO CRNA
Entity type:Organization
Organization Name:WAMEGO CRNA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALYCEA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-456-2295
Mailing Address - Street 1:711 GENN DR
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1179
Mailing Address - Country:US
Mailing Address - Phone:785-456-2295
Mailing Address - Fax:785-456-9467
Practice Address - Street 1:711 GENN DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1179
Practice Address - Country:US
Practice Address - Phone:785-456-2295
Practice Address - Fax:785-456-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144683OtherC. BROWN/ BLUE CROSS #
KS144577OtherC.ROSE/BLUE CROSS #
KS144576OtherWAMEGO CRNA BLUE CROSS #
KS=========OtherWAMEGO CRNA TAX ID #