Healthcare Provider Details

I. General information

NPI: 1932200276
Provider Name (Legal Business Name): MARY DAMERY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

IV. Provider business mailing address

8147 US HIGHWAY 23 S
OSSINEKE MI
49766-9559
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7390
  • Fax: 989-356-8013
Mailing address:
  • Phone:
  • Fax: 989-356-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704147757
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: