Healthcare Provider Details

I. General information

NPI: 1073186136
Provider Name (Legal Business Name): PHILIP LYNWOOD KEARSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6819
  • Fax: 603-609-6821
Mailing address:
  • Phone: 603-609-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number092542-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: