Healthcare Provider Details

I. General information

NPI: 1801373923
Provider Name (Legal Business Name): ALEXIS CARRIERE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS MIANO CRNA

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06106-3300
US

IV. Provider business mailing address

81 STEEPLECHASE DR
MANCHESTER CT
06040-7066
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-5000
  • Fax:
Mailing address:
  • Phone: 860-655-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN2321940
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8953
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: