Provider Demographics
NPI:1568033678
Name:BENDA, NICHOLAS RICHARD (CRNA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RICHARD
Last Name:BENDA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 LONGYEAR DR
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9602
Mailing Address - Country:US
Mailing Address - Phone:906-371-0053
Mailing Address - Fax:
Practice Address - Street 1:47 LONGYEAR DR
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9602
Practice Address - Country:US
Practice Address - Phone:906-371-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704362384367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered