Healthcare Provider Details

I. General information

NPI: 1760652630
Provider Name (Legal Business Name): ELIZABETH BRANCONNIER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST DEPT OF ANESTHESIOLOGY
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

75 NEWMAN AVE SUITE 100
RUMFORD RI
02916-1945
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5284
  • Fax:
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA36669
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: