Healthcare Provider Details

I. General information

NPI: 1194001362
Provider Name (Legal Business Name): CHRISTINA MARIE FELLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 GRAND AVE UNIT 205
NEW HAVEN CT
06511-4974
US

IV. Provider business mailing address

850 GRAND AVE UNIT 205
NEW HAVEN CT
06511-4974
US

V. Phone/Fax

Practice location:
  • Phone: 210-478-1382
  • Fax:
Mailing address:
  • Phone: 210-478-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4913
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: