Healthcare Provider Details

I. General information

NPI: 1710086681
Provider Name (Legal Business Name): BERNARD A KUZAVA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W GREEN ST
HASTINGS MI
49058
US

IV. Provider business mailing address

P O BOX 382
HASTINGS MI
49058
US

V. Phone/Fax

Practice location:
  • Phone: 269-945-3451
  • Fax:
Mailing address:
  • Phone: 269-945-2176
  • Fax: 269-945-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704115815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: