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General NPI Number Information
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NPI Number | 1053663625
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Entity Type | Individual
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Provider Name | CRYSTAL ANNEQUA GRANT CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 690 CANTON ST #325
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City | WESTWOOD
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State | MA
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Zip | 02090-2321
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Country | US
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Telephone | 781-407-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 22 ROOSEVELT AVE
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City | CHICOPEE
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State | MA
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Zip | 01013-2906
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Country | US
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Telephone | 413-687-9425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 284428
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 284428
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 92299
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License Number State | NC
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