Healthcare Provider Details

I. General information

NPI: 1699751016
Provider Name (Legal Business Name): ERIK CARAWAN CLINE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2005
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
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:
Mailing address:
  • Phone: 207-973-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA83401
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN R053637
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 2860722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: