Healthcare Provider Details

I. General information

NPI: 1326455890
Provider Name (Legal Business Name): MICHAEL KERNS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE DANBURY HOSPITAL
DANBURY CT
06810-6099
US

IV. Provider business mailing address

414 W 44TH ST APT 3F
NEW YORK NY
10036-5217
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: