Healthcare Provider Details

I. General information

NPI: 1093283509
Provider Name (Legal Business Name): BETHANY MICHELLE KOWALEWSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. BETHANY MICHELLE HEMMES

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

163 INTREPID LN STE 100
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4720
  • Fax:
Mailing address:
  • Phone: 316-469-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number711317
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number711317
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141269
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number711317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: