Healthcare Provider Details

I. General information

NPI: 1629022124
Provider Name (Legal Business Name): TRUDY ALIX PIERCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRUDY ALIX CRNA

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WISHING WELL WAY
WEST SPRINGFIELD MA
01089-4363
US

IV. Provider business mailing address

43 WISHING WELL WAY
WEST SPRINGFIELD MA
01089-4363
US

V. Phone/Fax

Practice location:
  • Phone: 413-785-1327
  • Fax: 413-785-1327
Mailing address:
  • Phone: 413-785-1327
  • Fax: 413-785-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number174437
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: