Healthcare Provider Details

I. General information

NPI: 1205005360
Provider Name (Legal Business Name): CHARLENE A BASILE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST HUNT CENTER
DANVERS MA
01923-2121
US

IV. Provider business mailing address

6 KENMORE DR
DANVERS MA
01923-1127
US

V. Phone/Fax

Practice location:
  • Phone: 978-646-7088
  • Fax: 978-777-1462
Mailing address:
  • Phone: 978-774-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number247678
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: