Healthcare Provider Details

I. General information

NPI: 1720309560
Provider Name (Legal Business Name): RONAN JAMES ARMADA CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ARMSTRONG RD
SHELTON CT
06484
US

IV. Provider business mailing address

22 DALECOT DR
TRUMBULL CT
06611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7353
  • Fax: 203-929-0756
Mailing address:
  • Phone: 203-434-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number004580
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: