Provider Demographics
NPI:1093283509
Name:KOWALEWSKI, BETHANY MICHELLE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MICHELLE
Last Name:KOWALEWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:HEMMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 INTREPID LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2548
Mailing Address - Country:US
Mailing Address - Phone:316-469-1130
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711317163WN0003X, 163WP0200X, 367500000X
PA141269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty