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General NPI Number Information
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NPI Number | 1144679390
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Entity Type | Individual
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Provider Name | DANIELLE DUBUC CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST MMC ANESTHESIA & PAIN MANAGMENT
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2526
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Fax | 207-662-6236
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Provider Business Mailing Address
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Address Line | 99 CHARLES ST
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City | LEWISTON
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State | ME
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Zip | 04240-4819
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Country | US
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Telephone | 207-577-4111
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RNA163013
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License Number State | ME
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