Provider Demographics
NPI:1336321983
Name:BURNETT, BEN E (CRNA)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:E
Last Name:BURNETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CHESTERFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7002
Mailing Address - Country:US
Mailing Address - Phone:843-537-7881
Mailing Address - Fax:843-320-3481
Practice Address - Street 1:711 CHESTERFIELD HWY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7002
Practice Address - Country:US
Practice Address - Phone:843-537-7881
Practice Address - Fax:843-320-3481
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR52394367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0893Medicaid
SC195743OtherUNISON
SC2004374OtherSELECT HEALTH
NC8051531Medicaid
SC$$$$$$$$$OtherBCBS
SC$$$$$$$$$OtherTRICARE