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General NPI Number Information
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NPI Number | 1932200276
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Entity Type | Individual
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Provider Name | MARY DAMERY CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 W CHISHOLM ST
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City | ALPENA
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State | MI
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Zip | 49707-1401
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Country | US
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Telephone | 989-356-7390
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Fax | 989-356-8013
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Provider Business Mailing Address
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Address Line | 8147 US HIGHWAY 23 S
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City | OSSINEKE
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State | MI
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Zip | 49766-9559
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Country | US
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Telephone |
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Fax | 989-356-8013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704147757
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License Number State | MI
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