Healthcare Provider Details

I. General information

NPI: 1689804205
Provider Name (Legal Business Name): ALISA MAE VROMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 BROADWAY
BANGOR ME
04401-2401
US

IV. Provider business mailing address

PO BOX 15
SALSBURY COVE ME
04672-0015
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-6226
  • Fax: 207-992-2756
Mailing address:
  • Phone: 207-288-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2002015923
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number252255
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA183050
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: