Healthcare Provider Details

I. General information

NPI: 1386887263
Provider Name (Legal Business Name): JEFFREY B. NORDIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ANESTHESIA 20 YORK STREET
NEW HAVEN CT
06510-8051
US

IV. Provider business mailing address

YALE UNIVERSITY-ANESTHESIA 333 CEDAR ST, TMP3
NEW HAVEN CT
06510-8051
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number551730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3783
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number004706
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: