Individual
KATHERINE MASCOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(313) 745-3607
Mailing address
PO BOX 67000, DEPT 203401, DETROIT, MI 48267-0002
(888) 278-4126
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704209276
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346421062
—
MI
01
—
4308672870
BLUE CROSS OF MI
MI
Enumeration date
11/21/2007
Last updated
11/07/2008
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