Provider Demographics
NPI:1831948793
Name:BEDINGHAUS, CARY COULTER (CRNA)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:COULTER
Last Name:BEDINGHAUS
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 1:1486 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2767
Mailing Address - Country:US
Mailing Address - Phone:614-638-1185
Mailing Address - Fax:
Practice Address - Street 1:710 CHIPPEWA SQ STE 103
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4819
Practice Address - Country:US
Practice Address - Phone:906-226-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704412961NSA240C3367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered