Individual
MR. BENJAMIN SHANE NUTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
914 PINE STREET, MOUNT SHASTA, CA 96067
(530) 926-6111
(530) 926-0245
Mailing address
914 PINE STREET, MOUNT SHASTA, CA 96067
(530) 926-6111
(530) 926-0245
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05502
WELLMARK BCBS
IA
Enumeration date
06/21/2007
Last updated
02/22/2018
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