Healthcare Provider Details

I. General information

NPI: 1508344367
Provider Name (Legal Business Name): SETH NEUTS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 12/15/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3175
US

IV. Provider business mailing address

124 SAUGUS ST
PORTLAND ME
04103-1469
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2526
  • Fax:
Mailing address:
  • Phone: 207-615-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2319849
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2319849
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA243063
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: