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General NPI Number Information
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NPI Number | 1588624605
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Entity Type | Individual
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Provider Name | NANDRA D. MANSARAM CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 4725 N. FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4603
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Country | US
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Telephone | 954-771-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 HOGBACK RD. SUITE 5A
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City | ANN ARBOR
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State | MI
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Zip | 48105-9750
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Country | US
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Telephone | 734-263-2414
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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 | ARNP3201622
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License Number State | FL
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