MEDICARE: KATHLEEN WERNETTE 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
1	367500000X	Certified Registered Nurse Anesthetist	RN544967	CA

General Provider Information

NPI Number	:	1780857334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WERNETTE CRNA

Provider Business Mailing Address
First Line	:	17736 NEARBANK DR
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4240
Country	:	US
Telephone Number	:	818-744-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	17736 NEARBANK DR
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4240
Country	:	US
Telephone Number	:	818-744-0626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2008
Last Update Date	:	11/18/2021

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