Healthcare Provider Details

I. General information

NPI: 1013251941
Provider Name (Legal Business Name): STACEY C DOSTIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY C TAYLOR CRNA

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1959
  • Fax: 207-430-4007
Mailing address:
  • Phone: 207-622-1959
  • Fax: 207-430-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9207570
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA143030
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: