Provider Demographics
NPI:1639105596
Name:BENNA-MALLETTE, CATHERINE ABBIE (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ABBIE
Last Name:BENNA-MALLETTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ABBIE
Other - Last Name:VERZARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5859 SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-7633
Mailing Address - Country:US
Mailing Address - Phone:518-461-9233
Mailing Address - Fax:
Practice Address - Street 1:5859 SWALLOW DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-7633
Practice Address - Country:US
Practice Address - Phone:518-461-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317321367500000X
TXAP126630367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered