Healthcare Provider Details

I. General information

NPI: 1851353460
Provider Name (Legal Business Name): MARY SUZANNE NADOLNY RN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY NADOLNY RAPPOLA RN CRNA

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3175
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-5410
  • Fax: 207-661-2033
Mailing address:
  • Phone: 207-661-5410
  • Fax: 207-661-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167002
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001201718
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA193008
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: