Provider Demographics
NPI:1871563296
Name:KLINGER, SHERIDAN D (CRNA)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:D
Last Name:KLINGER
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 1:900 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1362
Mailing Address - Country:US
Mailing Address - Phone:541-963-1401
Mailing Address - Fax:541-963-1502
Practice Address - Street 1:900 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1362
Practice Address - Country:US
Practice Address - Phone:541-963-1401
Practice Address - Fax:541-963-1502
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200760012CRNA367500000X
NMCRNA00769367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809486Medicaid
UTT1110Medicaid
NM52274756Medicaid
CO65157346Medicaid
UTT1110Medicaid