Healthcare Provider Details

I. General information

NPI: 1972540094
Provider Name (Legal Business Name): EDWARD CURTIS WIRTH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/13/2026
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WELLS ST
WESTERLY RI
02891-2922
US

IV. Provider business mailing address

25 WELLS ST
WESTERLY RI
02891-2922
US

V. Phone/Fax

Practice location:
  • Phone: 860-204-6167
  • Fax:
Mailing address:
  • Phone: 860-204-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number001302
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: