Healthcare Provider Details

I. General information

NPI: 1689106924
Provider Name (Legal Business Name): RACHEL PETREE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRAP FALLS ROAD SUITE 414
SHELTON CT
06484
US

IV. Provider business mailing address

99 EAST RIVER DRIVE 5TH FLOOR
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7353
  • Fax: 203-929-0756
Mailing address:
  • Phone: 860-282-0833
  • Fax: 860-282-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number111111
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7126
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: