Provider Demographics
NPI:1225038813
Name:SMITH, DURRELL (CRNA)
Entity Type:Individual
Prefix:
First Name:DURRELL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HAMPSHIRE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4920
Mailing Address - Country:US
Mailing Address - Phone:603-228-6716
Mailing Address - Fax:
Practice Address - Street 1:5 COLISEUM AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3206
Practice Address - Country:US
Practice Address - Phone:603-882-9800
Practice Address - Fax:603-882-0556
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH029123-21367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE2811Medicare ID - Type UnspecifiedPROVIDER NUMBER