Healthcare Provider Details

I. General information

NPI: 1871585547
Provider Name (Legal Business Name): RAMONA M DOMEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GUAM ANESTHESIA DEPT
FPO AP
96538-0490
US

IV. Provider business mailing address

184 JUAN M CRUZ DR
SANTA RITA GU
96915-1743
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9304
  • Fax:
Mailing address:
  • Phone: 671-344-9386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number51740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: