Healthcare Provider Details

I. General information

NPI: 1184691149
Provider Name (Legal Business Name): ERIKA ANNE GREENE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CANTON ST SUITE 325
WESTWOOD MA
02090-2321
US

IV. Provider business mailing address

690 CANTON ST STE 325
WESTWOOD MA
02090-2324
US

V. Phone/Fax

Practice location:
  • Phone: 781-407-7712
  • Fax: 781-407-0998
Mailing address:
  • Phone: 937-641-3350
  • Fax: 937-641-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704230163
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2303484
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.14067-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: