Healthcare Provider Details

I. General information

NPI: 1366598849
Provider Name (Legal Business Name): BONNIE SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS STREET ST. LUKES HOSPITAL
NEWBURGH NY
12550
US

IV. Provider business mailing address

2 CATHARINE STREET, PO BOX 550 MID-HUDSON ANESTHESIOLOGISTS, PC
POUGHKEEPSIE NY
12602
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax:
Mailing address:
  • Phone: 866-885-2318
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4999381
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number499938-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: