Active NPI
Connie Colleen Mykleby, CRNA
- Certified Registered Nurse Anesthetist
- Davenport, IA
National Provider Identifier
1700862406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 062389
- Practice address
- 1227 East Rusholme Street
Davenport, IA 52803-2498 - Phone
- (563) 421-1000
- Fax
- (563) 421-7889
- NPI assigned
- Dec 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 062389 | IA | Primary |
Addresses
Primary practice location
1227 East Rusholme Street
Davenport, IA 52803-2498
Mailing address
PO Box 1245
Bettendorf, IA 52722-0021
Phone (563) 324-8160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1119479 | Medicaid | IA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | connie.mykleby@direct.genesishealth.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062389 | IA | MD | Certified Registered Nurse Anesthetist |
Interoperability endpoints
- connie.mykleby@direct.genesishealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617580800000",
"number": "1700862406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1245",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527220021",
"telephone_number": "563-324-8160",
"fax_number": "563-324-8486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1227 EAST RUSHOLME STREET",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032498",
"telephone_number": "563-421-1000",
"fax_number": "563-421-7889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYKLEBY",
"first_name": "CONNIE",
"middle_name": "COLLEEN",
"name_prefix": "Mrs.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-15",
"last_updated": "2021-04-05",
"certification_date": "2021-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IA",
"license": "062389",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1119479",
"state": "IA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "connie.mykleby@direct.genesishealth.com",
"affiliation": "N",
"endpointDescription": "Genesis Health System Direct Email Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "1227 East Rusholme Street",
"city": "Davenport",
"state": "IA",
"country_code": "US",
"postal_code": "528032498",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.