Provider Demographics
NPI:1881687705
Name:KENDALL, GEORGE D (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:KENDALL
Suffix:
Gender:M
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3510
Mailing Address - Country:US
Mailing Address - Phone:740-380-8068
Mailing Address - Fax:740-380-8152
Practice Address - Street 1:2900 W 16TH STREET
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-275-1200
Practice Address - Fax:812-275-1212
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-240448367500000X
IN28200961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28200961OtherRN
OH2397973Medicaid
IN28200961OtherRN
OHS50695Medicare UPIN