Provider Demographics
NPI:1861822116
Name:LOUDNER, MICHAEL LEE (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:LOUDNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5784 WIDEWATERS PKWY
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1890
Mailing Address - Country:US
Mailing Address - Phone:315-469-1130
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST RM 4143
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1834
Practice Address - Country:US
Practice Address - Phone:315-469-4891
Practice Address - Fax:315-464-4905
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY535456163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse