Provider Demographics
NPI:1154488708
Name:YEWDALL, GARY STEVEN SR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVEN
Last Name:YEWDALL
Suffix:SR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 MANNING ST
Mailing Address - Street 2:APT 315
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:603-490-3777
Mailing Address - Fax:
Practice Address - Street 1:ONE ELLIOT WAY SUITE 200
Practice Address - Street 2:AMOSKEAG ANESTHESIA ASSOC
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-663-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH0502662311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered