Healthcare Provider Details

I. General information

NPI: 1538182886
Provider Name (Legal Business Name): GUNVOR MARITA LOWE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLD ROAD TO NINE ACRE CORNER EMERSON HOSPITAL, ANESTHESIA DEPARTMENT
CONCORD MA
01742
US

IV. Provider business mailing address

28 ALCOTT ST
ACTON MA
01720-5545
US

V. Phone/Fax

Practice location:
  • Phone: 978-278-3162
  • Fax: 978-287-3508
Mailing address:
  • Phone: 978-263-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number020803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: