Healthcare Provider Details

I. General information

NPI: 1033223789
Provider Name (Legal Business Name): SUSAN LIND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

PO BOX 404
BANGOR ME
04402-0404
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4519
  • Fax: 207-992-4132
Mailing address:
  • Phone: 207-973-4519
  • Fax: 207-992-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number50981
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: