Healthcare Provider Details

I. General information

NPI: 1104065960
Provider Name (Legal Business Name): PETER V ARNOLD CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD
BRISTOL CT
06010-5161
US

IV. Provider business mailing address

75 WASHINGTON DR
SOUTHINGTON CT
06489-4329
US

V. Phone/Fax

Practice location:
  • Phone: 860-558-7543
  • Fax:
Mailing address:
  • Phone: 860-558-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number004020
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: