Healthcare Provider Details

I. General information

NPI: 1902840408
Provider Name (Legal Business Name): CATHERINE P REIDY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 ALLEN ST
SPRINGFIELD MA
01118-2533
US

IV. Provider business mailing address

690 CANTON ST STE 325
WESTWOOD MA
02090-2324
US

V. Phone/Fax

Practice location:
  • Phone: 413-796-7494
  • Fax: 413-796-7498
Mailing address:
  • Phone: 413-796-7494
  • Fax: 413-796-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number182984
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: