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General NPI Number Information
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NPI Number | 1568883502
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Entity Type | Individual
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Provider Name | JOSEPH BOURASSA JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 20 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-2615
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Fax | 203-497-0635
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Provider Business Mailing Address
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Address Line | 315 REEDS GAP RD
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City | NORTHFORD
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State | CT
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Zip | 06472-1104
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Country | US
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Telephone | 413-204-5819
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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 | 098146
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License Number State | CT
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