MEDICARE: MS. PAULEEN REYES CONSEBIDO CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	002653	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205812401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULEEN REYES CONSEBIDO CRNA

Provider Business Mailing Address
First Line	:	65 HUMISTON DR
Second Line	:
City	:	BETHANY
State	:	CT
Zip	:	06524-3175
Country	:	US
Telephone Number	:	203-891-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 HUMISTON DR
Second Line	:
City	:	BETHANY
State	:	CT
Zip	:	06524-3175
Country	:	US
Telephone Number	:	203-891-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	09/23/2011

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