Healthcare Provider Details

I. General information

NPI: 1053939231
Provider Name (Legal Business Name): DANIEL GUILMETTE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

360 MAIN ST
CROMWELL CT
06416-2305
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-9666
  • Fax: 860-714-8110
Mailing address:
  • Phone: 860-622-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number82444
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8940
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: