Healthcare Provider Details

I. General information

NPI: 1114022415
Provider Name (Legal Business Name): ELIZABETH ANN BRADY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SUMNER ST
STOUGHTON MA
02072-3396
US

IV. Provider business mailing address

5 TYSON RD
SOUTH EASTON MA
02375-1022
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-2325
  • Fax:
Mailing address:
  • Phone: 508-238-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number122860
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: