Healthcare Provider Details

I. General information

NPI: 1578842746
Provider Name (Legal Business Name): NICOLE L DALTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE L VOLPICELLI CRNA

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-1200
  • Fax:
Mailing address:
  • Phone: 978-741-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: