Healthcare Provider Details

I. General information

NPI: 1457320335
Provider Name (Legal Business Name): EDWARD ODILON CYR CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 FRANCA DR
BRISTOL RI
02809-4712
US

IV. Provider business mailing address

47 FRANCA DR
BRISTOL RI
02809-4712
US

V. Phone/Fax

Practice location:
  • Phone: 401-254-2618
  • Fax:
Mailing address:
  • Phone: 401-254-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number130129
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: