Healthcare Provider Details

I. General information

NPI: 1992898522
Provider Name (Legal Business Name): SUSAN STONE HOLLORAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN STONE CRNA

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEDICAL CENTER DR
BRUNSWICK ME
04011-2652
US

IV. Provider business mailing address

123 MEDICAL CENTER DR
BRUNSWICK ME
04011-2652
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-6000
  • Fax: 207-373-6080
Mailing address:
  • Phone: 207-373-6000
  • Fax: 207-373-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11019483
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA83057
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: