Provider Demographics
NPI:1538148010
Name:KIBART, MARY (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KIBART
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 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-997-1274
Mailing Address - Fax:508-910-2209
Practice Address - Street 1:51 STATE RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-997-1274
Practice Address - Fax:508-910-2209
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111224367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0478Medicare ID - Type Unspecified