Healthcare Provider Details

I. General information

NPI: 1447212816
Provider Name (Legal Business Name): DONALD I. BEAUDOIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 KATHY TRL
UXBRIDGE MA
01569
US

IV. Provider business mailing address

20 KATHY TRL
UXBRIDGE MA
01569
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-9016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN144541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: