MEDICARE: PROF. CONNIE LYNNE LORETTE 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	029653-23-11	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	029653-21	OTHER	NH	REGISTERED NURSE LICENSE
2	029653-23-11	OTHER	NH	ARNP - CRNA LICENSE

General Provider Information

NPI Number	:	1689666711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. CONNIE LYNNE LORETTE CRNA

Provider Business Mailing Address
First Line	:	1 ELLIOT WAY
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3502
Country	:	US
Telephone Number	:	603-647-9325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ELLIOT WAY
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3502
Country	:	US
Telephone Number	:	603-663-2315
Fax Number	:	603-647-9180

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	05/07/2021

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