Healthcare Provider Details

I. General information

NPI: 1760464010
Provider Name (Legal Business Name): NATALIE F DHAMERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

IV. Provider business mailing address

41 RIDGE RD
MARQUETTE MI
49855-9480
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3406
  • Fax: 906-225-3094
Mailing address:
  • Phone: 906-249-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number082154-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704170904
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: