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NPI Code Detail

MEDICARE: MARA TRUDGEN CRNA, DNP

MEDICARE: MARA TRUDGEN CRNA, DNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704299352MI

General Provider Information

NPI Number : 1134790116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA TRUDGEN CRNA, DNP
Provider Business Mailing Address
First Line : 4784 CLYDE RD
Second Line :
City : HOWELL
State : MI
Zip : 48855-6749
Country : US
Telephone Number : 517-812-6139
Fax Number :
Provider Business Practice Location Address
First Line : 1 GENESYS PKWY
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-8065
Country : US
Telephone Number : 810-606-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 05/29/2026

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