Healthcare Provider Details

I. General information

NPI: 1063075026
Provider Name (Legal Business Name): ANNE CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE BENSCHEIDT CRNA

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COTTONWOOD CT STE D150
EAGLE ID
83616-6576
US

IV. Provider business mailing address

PO BOX 34148
BELFAST ME
04915-0619
US

V. Phone/Fax

Practice location:
  • Phone: 208-917-2713
  • Fax: 208-955-2029
Mailing address:
  • Phone: 208-917-2713
  • Fax: 208-955-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number65195
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number65195
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: