Healthcare Provider Details

I. General information

NPI: 1861842593
Provider Name (Legal Business Name): KAREN VALDES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-0001
US

IV. Provider business mailing address

112 OSCEOLA AVE
WORCESTER MA
01606-1836
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN237900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: