Healthcare Provider Details

I. General information

NPI: 1043688815
Provider Name (Legal Business Name): TRARI BOWDISH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TRARI CRUMRIN

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COOPER AVE
SAGINAW MI
48602-5383
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone: 989-583-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704258148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: