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General NPI Number Information
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NPI Number | 1164409009
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Entity Type | Individual
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Provider Name | SVETLANA IVANOV CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 738 WASHINGTON ST
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City | ATTLEBORO
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State | MA
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Zip | 02703-6948
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Country | US
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Telephone | 508-761-6025
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MARBURY AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-6102
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Country | US
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Telephone | 401-580-8419
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Fax | 401-444-6912
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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 | RN244569
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License Number State | MA
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