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NPI Code Detail

MEDICARE: MARY BIGONGIARI CRNA

MEDICARE: MARY BIGONGIARI CRNA
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 AnesthetistIL

General Provider Information

NPI Number : 1598740284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BIGONGIARI CRNA
Provider Business Mailing Address
First Line : PO BOX 503734
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-0001
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4701
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 07/08/2007

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Directions to “ MARY BIGONGIARI CRNA” Practice Location

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