Healthcare Provider Details

I. General information

NPI: 1891916557
Provider Name (Legal Business Name): LAURA DECANDIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MCLEAN CRNA

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 ALLEN ST
SPRINGFIELD MA
01118-2533
US

IV. Provider business mailing address

PO BOX 983122
BOSTON MA
02298-3122
US

V. Phone/Fax

Practice location:
  • Phone: 413-796-7494
  • Fax: 413-796-7498
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number235813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: