Healthcare Provider Details

I. General information

NPI: 1790767853
Provider Name (Legal Business Name): KATHRYN S BENDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

811 W KAYE AVE
MARQUETTE MI
49855-2614
US

V. Phone/Fax

Practice location:
  • Phone: 906-486-4431
  • Fax:
Mailing address:
  • Phone: 906-226-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704157469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: