Healthcare Provider Details

I. General information

NPI: 1043842313
Provider Name (Legal Business Name): BRITTANY M LEDUC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

13 ATWELLS AVE
JOHNSTON RI
02919-3324
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-1610
  • Fax:
Mailing address:
  • Phone: 401-524-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN02258
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: