Healthcare Provider Details

I. General information

NPI: 1669718789
Provider Name (Legal Business Name): SHANA M D'ANDREA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CAMPUS AVE ST MARY'S ANESTHESIA ASSOCIATES
LEWISTON ME
04240-6030
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-755-3715
  • Fax: 207-755-3728
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA123053
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: