Healthcare Provider Details

I. General information

NPI: 1962458646
Provider Name (Legal Business Name): PETER WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SEASIDE AVE SUITE 201
MILFORD CT
06460-4625
US

IV. Provider business mailing address

309 SEASIDE AVE SUITE 201
MILFORD CT
06460-4625
US

V. Phone/Fax

Practice location:
  • Phone: 860-738-0885
  • Fax:
Mailing address:
  • Phone: 860-738-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000037
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: