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1881696441

NPI Code Detail

MEDICARE: JUDITH ELIZABETH DEARBORN CRNA

MEDICARE: JUDITH ELIZABETH DEARBORN 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	101-0019794	VT
2	367500000X	Certified Registered Nurse Anesthetist	AA083008	ME
3	367500000X	Certified Registered Nurse Anesthetist	CRNA AA 110	AK
4	367500000X	Certified Registered Nurse Anesthetist	025110-23	NH

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
2	40Y003095NH02	OTHER		ANTHEM
3	277245	OTHER		HARVARD PILGRIM

General Provider Information

NPI Number	:	1881696441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ELIZABETH DEARBORN CRNA

Provider Business Mailing Address
First Line	:	PO BOX 140427
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99514-0427
Country	:	US
Telephone Number	:	907-338-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 DEBARR RD
Second Line	:	ALASKA REGIONAL HOSPITAL
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2932
Country	:	US
Telephone Number	:	907-276-1131
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	06/06/2019

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Directions to “ JUDITH ELIZABETH DEARBORN CRNA” Practice Location

Language	Start Address	Practice Location

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