Healthcare Provider Details

I. General information

NPI: 1598502916
Provider Name (Legal Business Name): TAYLOR MARISA HUNT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

77 RIDGE ST
MILLIS MA
02054-1107
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-1000
  • Fax:
Mailing address:
  • Phone: 508-847-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number158075
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2349145
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: