Individual
MARY JEAN DETCHEMENDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 783-4235
(704) 783-2527
Mailing address
102 HARBORGATE CT, CORNELIUS, NC 28031-5000
(704) 892-8372
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
096193
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050167
—
NC
Enumeration date
07/25/2006
Last updated
07/09/2007
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