Healthcare Provider Details

I. General information

NPI: 1912948399
Provider Name (Legal Business Name): JOHN STITT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FAHC-WP2
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE FAHC-WP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2415
  • Fax: 802-847-5324
Mailing address:
  • Phone: 802-847-2415
  • Fax: 802-847-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101-0018834
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: