Healthcare Provider Details

I. General information

NPI: 1770860975
Provider Name (Legal Business Name): CHARLIE J BEGNAUD II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 KINSLEY ST SUITE 4
NASHUA NH
03060-3634
US

IV. Provider business mailing address

2 WILLIAMS DR
HUDSON NH
03051-5431
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-1501
  • Fax: 603-882-9747
Mailing address:
  • Phone: 603-882-1501
  • Fax: 603-882-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number06528323
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28224409A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: