Provider Demographics
NPI:1922772482
Name:BESEAU, MARY KATELYN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATELYN
Last Name:BESEAU
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 1:291 JOY TRL
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-4809
Mailing Address - Country:US
Mailing Address - Phone:817-320-9427
Mailing Address - Fax:
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-572-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101669367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered