Provider Demographics
NPI:1861594822
Name:BARTHELMESS, MARY J CARTER (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J CARTER
Last Name:BARTHELMESS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULANN
Other - Middle Name:C
Other - Last Name:BARTHELMESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:400 MALL BLVD
Practice Address - Street 2:STE. T
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-355-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044367367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I430097Medicare PIN