Healthcare Provider Details

I. General information

NPI: 1316994957
Provider Name (Legal Business Name): KATHERINE RUSNAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/14/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BETHESDA HOSPITAL 2815 SOUTH SEACREST BLVD
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1892772
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.139173
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: