Healthcare Provider Details

I. General information

NPI: 1295893246
Provider Name (Legal Business Name): GRACE D. OBRIEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4305
  • Fax:
Mailing address:
  • Phone: 518-262-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number357134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: