Healthcare Provider Details

I. General information

NPI: 1508191941
Provider Name (Legal Business Name): BROOKE AMELIA SMITH STOWELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N MAIN ST #205
BREWER ME
04412-2011
US

IV. Provider business mailing address

489 STATE ST
BANGOR ME
04401-6616
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-4032
  • Fax: 207-992-4132
Mailing address:
  • Phone: 207-973-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR049759
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR97153
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN196287
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAA093048
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: