Healthcare Provider Details

I. General information

NPI: 1730909136
Provider Name (Legal Business Name): EVA KRISTINA VANOER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

IV. Provider business mailing address

30 PATERSON ST
PROVIDENCE RI
02906-5504
US

V. Phone/Fax

Practice location:
  • Phone: 401-736-4288
  • Fax:
Mailing address:
  • Phone: 312-805-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN79059
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN04408
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: