MEDICARE: JOSEPH GAUDETTE 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	1054180	TX
2	367500000X	Certified Registered Nurse Anesthetist	4040759	KY
3	163WC0200X	Critical Care Medicine Registered Nurse	RN.1678435	CO
4	163WC0200X	Critical Care Medicine Registered Nurse	R235866	MD

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689303950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GAUDETTE CRNA

Provider Business Mailing Address
First Line	:	34 FOREST HILLS DR
Second Line	:
City	:	NEW FAIRFIELD
State	:	CT
Zip	:	06812-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 40TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-1728
Country	:	US
Telephone Number	:	203-312-4226
Fax Number	:

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

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	04/06/2026

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