Healthcare Provider Details

I. General information

NPI: 1023027331
Provider Name (Legal Business Name): JOYCE MARIE WADE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WHITNEY AVE
HAMDEN CT
06518-3600
US

IV. Provider business mailing address

6 LARKINS WAY
FARMINGTON CT
06032-1723
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2555
  • Fax:
Mailing address:
  • Phone: 860-402-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number046010
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: