MEDICARE: LORETTA MADDEN-HOLMAN 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	174400000X	Specialist	0507212311	NH
2	367500000X	Certified Registered Nurse Anesthetist	RN2328063	MA
3	367500000X	Certified Registered Nurse Anesthetist	101970-875	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427055581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA MADDEN-HOLMAN CRNA

Provider Business Mailing Address
First Line	:	66 POWERHOUSE RD
Second Line	:	3RD FLOOR
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1324
Country	:	US
Telephone Number	:	516-626-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 WHITEHALL RD
Second Line	:	ANESTHESIA DEPARTMENT
City	:	ROCHESTER
State	:	NH
Zip	:	03867-3226
Country	:	US
Telephone Number	:	603-335-8419
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/05/2024

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