Healthcare Provider Details

I. General information

NPI: 1316906829
Provider Name (Legal Business Name): MARY K. WHITMIRE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE ST
BOSTON MA
02130-3446
US

IV. Provider business mailing address

1153 CENTRE ST
BOSTON MA
02130-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-7000
  • Fax:
Mailing address:
  • Phone: 617-983-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number57
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2271470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: