Healthcare Provider Details

I. General information

NPI: 1992273221
Provider Name (Legal Business Name): KAITLIN STIRLING SANBORN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

187 S PINE AVE APT 2
ALBANY NY
12208-2013
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3125
  • Fax:
Mailing address:
  • Phone: 607-437-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number684852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: