Provider Demographics
NPI:1043280001
Name:DREDLA, JAMES EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:DREDLA
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0388
Mailing Address - Country:US
Mailing Address - Phone:316-281-3700
Mailing Address - Fax:316-282-4322
Practice Address - Street 1:1104 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100337367500000X
SDCR000216367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5750643Medicaid
NE38160OtherBCBS
NE45045877100Medicaid
IA0946418Medicaid
SD7671OtherBCBS
SD7671OtherBCBS
SD430060521Medicare PIN