MEDICARE: MR. JOEL PATRICK LAROSE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	002040	CT

General Provider Information

NPI Number	:	1134192420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL PATRICK LAROSE CRNA

Provider Business Mailing Address
First Line	:	2 OAK HILLS TRL
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1234
Country	:	US
Telephone Number	:	860-464-5514
Fax Number	:	860-464-5514

Provider Business Practice Location Address
First Line	:	2 OAK HILLS TRL
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1234
Country	:	US
Telephone Number	:	860-464-5514
Fax Number	:	860-464-5514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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