Healthcare Provider Details

I. General information

NPI: 1679809859
Provider Name (Legal Business Name): PATRICIA CK KEARNAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PROSPECT ST
MILFORD MA
01757-3003
US

IV. Provider business mailing address

14 PROSPECT ST
MILFORD MA
01757-3003
US

V. Phone/Fax

Practice location:
  • Phone: 508-902-9705
  • Fax: 508-902-9707
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN260700
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: