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Individual

BETTY JENNELL BACH

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
C.R.N.A.

Contact information

Practice address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 331-3000
(913) 341-5797
Mailing address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 331-3000
(913) 341-5797

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041343
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110375
HEALTHLINK
MO
01
166636
BCBS
MO
01
A155
CHAMPUS TRICARE
MO
01
P00035293
RAILROAD MEDICARE
MO
Enumeration date
04/06/2006
Last updated
07/08/2007
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