Healthcare Provider Details

I. General information

NPI: 1740294701
Provider Name (Legal Business Name): CLAUDELLE NATIVIDAD LE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHAPEL ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

50 WHISPERING HOLLOW CT
CHESHIRE CT
06410-3319
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3852
  • Fax: 203-865-2983
Mailing address:
  • Phone: 203-699-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number002426
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: