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NPI Code Detail

MEDICARE: MRS. RUTH L TICKNOR C.R.N.A.

MEDICARE: MRS. RUTH L TICKNOR C.R.N.A.
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
1367500000XCertified Registered Nurse Anesthetist101-0026096VT

General Provider Information

NPI Number : 1437159225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RUTH L TICKNOR C.R.N.A.
Provider Business Mailing Address
First Line : ONE MEDICAL CENTER DR
Second Line : DHMC DEPARTMENT OF ANESTHESIA
City : LEBANON
State : NH
Zip : 03756-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : ONE MEDICAL CENTER DRIVE
Second Line : DHMC DEPARTMENT OF ANESTHESIA
City : LEBANON
State : NH
Zip : 03756-0001
Country : US
Telephone Number : 603-650-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 11/29/2007

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