Healthcare Provider Details

I. General information

NPI: 1396211991
Provider Name (Legal Business Name): QUENTIN R. SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: QUENTIN R SMITH CRNA

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 08/15/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

24 HOSPITAL AVE
DANBURY CT
06810-6077
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7000
  • Fax:
Mailing address:
  • Phone: 203-739-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number185989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2330179
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2330179
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10289
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: