Healthcare Provider Details

I. General information

NPI: 1306178058
Provider Name (Legal Business Name): MERYN RITA BORASKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 PARKER ST
ROXBURY CROSSING MA
02120-3024
US

IV. Provider business mailing address

813 PARKER ST
ROXBURY CROSSING MA
02120-3024
US

V. Phone/Fax

Practice location:
  • Phone: 617-413-5366
  • Fax:
Mailing address:
  • Phone: 617-413-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN263991
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: