Healthcare Provider Details

I. General information

NPI: 1588696173
Provider Name (Legal Business Name): WILTON ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTHWESTERN DR
BLOOMFIELD CT
06002-3444
US

IV. Provider business mailing address

400 10TH ST E
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 888-209-0305
  • Fax:
Mailing address:
  • Phone: 888-209-0305
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000086
License Number StateCT

VIII. Authorized Official

Name: RICHARD J. AMIONE
Title or Position: AUTHORIZED OFFICIAL / PARTNER
Credential: CRNA
Phone: 303-834-2847