Individual
TRISTAN BLAKE BENNETT
Active
Individual
TRISTAN BLAKE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C002981
AR
367500000X
Certified Registered Nurse Anesthetist
CTP000234
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197567001
—
AR
01
—
P01230606
RR MEDICARE
AR
Enumeration date
04/25/2013
Last updated
12/12/2013
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