Healthcare Provider Details

I. General information

NPI: 1265676365
Provider Name (Legal Business Name): JOAN MARIE BOTELHO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 REEDSDALE RD
MILTON MA
02186-3926
US

IV. Provider business mailing address

199 REEDSDALE RD
MILTON MA
02186-3926
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3364
  • Fax: 617-664-5013
Mailing address:
  • Phone: 617-667-3364
  • Fax: 617-664-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number253681
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: