Provider Demographics
NPI:1780857334
Name:WERNETTE, KATHLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WERNETTE
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 1:17736 NEARBANK DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4240
Mailing Address - Country:US
Mailing Address - Phone:818-744-0626
Mailing Address - Fax:
Practice Address - Street 1:17736 NEARBANK DR
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-4240
Practice Address - Country:US
Practice Address - Phone:818-744-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN544967367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered