Healthcare Provider Details

I. General information

NPI: 1487639407
Provider Name (Legal Business Name): RICHARD J. AMIONE C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MOUNTAIN RD
WILTON CT
06897-1528
US

IV. Provider business mailing address

252 MOUNTAIN RD
WILTON CT
06897-1528
US

V. Phone/Fax

Practice location:
  • Phone: 203-834-2847
  • Fax: 203-834-2847
Mailing address:
  • Phone: 203-834-2847
  • Fax: 203-834-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000086
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: