Healthcare Provider Details

I. General information

NPI: 1952495897
Provider Name (Legal Business Name): LINDA THERESA DATTIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LINCOLN ST DEPARTMENT OF ANESTHESIOLOGY
WORCESTER MA
01605-2138
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-5897
  • Fax: 508-334-5179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN89076
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: