Healthcare Provider Details

I. General information

NPI: 1790083764
Provider Name (Legal Business Name): AMY CRESPO-BARAJAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

41B BUSH HILL RD
PELHAM NH
03076-3004
US

V. Phone/Fax

Practice location:
  • Phone: 978-902-4452
  • Fax:
Mailing address:
  • Phone: 978-902-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: