Healthcare Provider Details

I. General information

NPI: 1023409596
Provider Name (Legal Business Name): BRIANNA L. MULLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

LAHEY PROVIDER ENROLLMENT DEPARTMENT 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-3271
  • Fax: 508-856-5911
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN282856
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: