Healthcare Provider Details

I. General information

NPI: 1497099519
Provider Name (Legal Business Name): WANDA A. COLON ROMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HOSPITAL RD DEPARTMENT OF ANESTHESIOLOGY
LEOMINSTER MA
01453-2205
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2931
  • Fax: 978-466-2779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2288468
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: