Individual
MR. JAY BIESENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 234-8161
Mailing address
401 CHARLESTON DR, CLAYTON, NC 27527-3950
(919) 553-4527
(919) 553-4527
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
127107
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
28230243A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201384080
—
IN
05
—
8052067
—
NC
Enumeration date
07/20/2005
Last updated
06/17/2025
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