Healthcare Provider Details

I. General information

NPI: 1063453660
Provider Name (Legal Business Name): MARGARET MARY GILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

7261 SHORE RD APT.6V
BROOKLYN NY
11209-1862
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-4163
  • Fax:
Mailing address:
  • Phone: 718-745-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number164646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: