Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 163WG0000X | Registered Nurse | General Practice | R56262 | CONNECTICUT | No |
| 2 | 163WG0000X | Registered Nurse | General Practice | 145038 | MASSACHUSETTS | No |
| 3 | 367500000X | Nurse Anesthetist, Certified Registered | | 145038 | MASSACHUSETTS | No |
| 4 | 367500000X | Nurse Anesthetist, Certified Registered | | 002053 | CONNECTICUT | No |
| 5 | 367500000X | Nurse Anesthetist, Certified Registered | | 144244 | MISSOURI | No |
| 6 | 367500000X | Nurse Anesthetist, Certified Registered | | RNA36295 | RHODE ISLAND | No |
| 7 | 367500000X | Nurse Anesthetist, Certified Registered | | CCNA 036150 | NORTH CAROLINA | No |
| 8 | 163WG0000X | Registered Nurse | General Practice | 299390-1 | NEW YORK | No |
| 9 | 163WG0000X | Registered Nurse | General Practice | RN36295 | RHODE ISLAND | No |
| 10 | 163WG0000X | Registered Nurse | General Practice | 144244 | MISSOURI | No |
| 11 | 163WG0000X | Registered Nurse | General Practice | 0001122991 | VIRGINIA | No |
| 12 | 367500000X | Nurse Anesthetist, Certified Registered | | 0024122991 | VIRGINIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0970 60042 | MEDICARE ID-TYPE UNSPECIFIED | MISSOURI | |