Healthcare Provider Details

I. General information

NPI: 1780952564
Provider Name (Legal Business Name): BETH ANN SAWLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ROANOKE AVE
RIVERHEAD NY
11901-2031
US

IV. Provider business mailing address

333 ROUTE 25A SUITE225
ROCKY POINT NY
11778-8556
US

V. Phone/Fax

Practice location:
  • Phone: 631-548-6000
  • Fax:
Mailing address:
  • Phone: 631-744-3671
  • Fax: 631-744-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number354369-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: