Healthcare Provider Details

I. General information

NPI: 1154386522
Provider Name (Legal Business Name): PATRICIA STAMM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 BOSTON RD
WILBRAHAM MA
01095
US

IV. Provider business mailing address

PO BOX 2608
SPRINGFIELD MA
01101-2608
US

V. Phone/Fax

Practice location:
  • Phone: 413-599-4994
  • Fax: 413-599-4969
Mailing address:
  • Phone: 413-599-4994
  • Fax: 413-599-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number241320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: