Provider Demographics
NPI:1609872480
Name:MCKENNETT, ROBERT J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:MCKENNETT
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 1:640 S. STATE STREET, POB 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:DEPT OF ANES
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7088
Practice Address - Fax:302-744-6407
Is Sole Proprietor?:No
Enumeration Date:2005-06-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0034455 / L6-0A00367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered