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NPI Code Detail

MEDICARE: MR. IBRA L RIPLEY III CRNA, MSNA

MEDICARE: MR. IBRA L RIPLEY III CRNA, MSNA
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
1367500000XCertified Registered Nurse AnesthetistAA083200ME

General Provider Information

NPI Number : 1770588659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IBRA L RIPLEY III CRNA, MSNA
Provider Business Mailing Address
First Line : 300 MAIN ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7027
Country : US
Telephone Number : 207-795-0111
Fax Number :
Provider Business Practice Location Address
First Line : 300 MAIN ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7027
Country : US
Telephone Number : 207-795-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/23/2010

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