MEDICARE: SWEET DREAMS ANESTHESIA, LLC

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	R125035	MD

General Provider Information

NPI Number	:	1659579910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET DREAMS ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	18 BAYSIDE DR
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-5129
Country	:	US
Telephone Number	:	443-618-1571
Fax Number	:	410-287-3750

Provider Business Practice Location Address
First Line	:	18 BAYSIDE DR
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-5129
Country	:	US
Telephone Number	:	443-618-1571
Fax Number	:	410-287-3750

Authorized Official
Title or Position	:	SOLE PROPRIETOR/OWNER
Name	:	MRS. MARILYN ANNETTE FERGUSON
Credential	:	CRNA
Telephone Number	:	443-618-1571

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/29/2011

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