Provider Demographics
NPI:1285821157
Name:GENNETT, CALENE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CALENE
Middle Name:
Last Name:GENNETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CORLISS AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2060
Mailing Address - Country:US
Mailing Address - Phone:607-763-6735
Mailing Address - Fax:607-763-6736
Practice Address - Street 1:156 CORLISS AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-763-6735
Practice Address - Fax:607-763-6736
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5512831367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered