Healthcare Provider Details

I. General information

NPI: 1881073641
Provider Name (Legal Business Name): LA TOIA ALEXANDRE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

30 DRIFTWOOD DR
BRIDGEWATER MA
02324-1100
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN00709
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: