Healthcare Provider Details

I. General information

NPI: 1477531804
Provider Name (Legal Business Name): ROBERT SALVATORE LOGANO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
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

26197 PALACE LN UNIT 101
BONITA SPRINGS FL
34135-6242
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-3271
  • Fax: 508-856-5911
Mailing address:
  • Phone: 603-966-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2258183
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number046892-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9333173
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9333173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: