Healthcare Provider Details

I. General information

NPI: 1538157292
Provider Name (Legal Business Name): DAVID KENT ESMAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 WHITE MTN HWY THE MEMORIAL HOSP/ANESTHESIA DEPT
NORTH CONWAY NH
03860-5111
US

IV. Provider business mailing address

PO BOX 1326 48 POLLARD STREET
CONWAY NH
03818-1326
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-5467
  • Fax:
Mailing address:
  • Phone: 603-447-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number052508-23-11
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: