Healthcare Provider Details

I. General information

NPI: 1558684811
Provider Name (Legal Business Name): SANDRA RACHEL KLEIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST. GRAY-BIGELOW 444, MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF ANESTHESIA
BOSTON MA
02114
US

IV. Provider business mailing address

44 WASHINGTON ST APT 214
BROOKLINE MA
02445-7104
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3030
  • Fax:
Mailing address:
  • Phone: 303-909-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number279944
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: