Healthcare Provider Details

I. General information

NPI: 1013948736
Provider Name (Legal Business Name): AMY M STOWE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 MIDDLE ST
FALL RIVER MA
02721-1733
US

IV. Provider business mailing address

77 WARREN STREET PROVIDER ENROLLMENT
BRIGHTON MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-5258
  • Fax: 508-675-5671
Mailing address:
  • Phone: 617-562-5359
  • Fax: 617-562-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number243924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: