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General NPI Number Information
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NPI Number | 1578569133
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Entity Type | Individual
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Provider Name | DEIDRE VIAN GOLDSMITH C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 5401 OLD COURT RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5103
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Country | US
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Telephone | 410-521-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SHIRECREST
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City | AVON
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State | CT
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Zip | 06001-3965
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Country | US
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Telephone | 443-831-0093
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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 | R141638
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License Number State | MD
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