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General NPI Number Information
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NPI Number | 1508191941
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Entity Type | Individual
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Provider Name | BROOKE AMELIA SMITH STOWELL CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 141 N MAIN ST #205
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City | BREWER
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State | ME
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Zip | 04412-2011
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Country | US
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Telephone | 207-992-4032
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Fax | 207-992-4132
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Provider Business Mailing Address
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Address Line | 489 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-6616
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Country | US
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Telephone | 207-973-4519
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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 | R049759
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R97153
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN196287
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AA093048
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License Number State | ME
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