Healthcare Provider Details

I. General information

NPI: 1952681280
Provider Name (Legal Business Name): MARY EZEM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-5025
  • Fax:
Mailing address:
  • Phone: 305-654-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9169221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: