Healthcare Provider Details

I. General information

NPI: 1184865750
Provider Name (Legal Business Name): CAROLINE P. MACINTOSH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE H. PARK CRNA

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3118
US

IV. Provider business mailing address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3118
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-4224
  • Fax: 781-335-0429
Mailing address:
  • Phone: 781-337-4224
  • Fax: 781-335-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2260671
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: