Provider Demographics
NPI:1992037899
Name:BOZENSKI, MARC (CRNA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BOZENSKI
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 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-777-1096
Mailing Address - Fax:603-580-7210
Practice Address - Street 1:5 ALUMNI DR.
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-6624
Practice Address - Fax:603-580-6620
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH059042-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076389Medicaid