Healthcare Provider Details

I. General information

NPI: 1063429553
Provider Name (Legal Business Name): ESTELLE K MCINNIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MONTVALE AVENUE NORTHSHORE CATARACT & LASER CENTER
STONEHAM MA
02180
US

IV. Provider business mailing address

430 BOW LAKE RD
NORTHWOOD NH
03261-3318
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-5995
  • Fax:
Mailing address:
  • Phone: 603-942-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118154
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: