Provider Demographics
NPI:1265490130
Name:BREITENSTEIN, SCOTT E (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:BREITENSTEIN
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:YAMINS 219
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3364
Mailing Address - Fax:617-667-5013
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:YAMINS 219
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3364
Practice Address - Fax:617-667-5013
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN228993367500000X
RIAPRN00879367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001803OtherBLUE CHIP PROVIDER #
RI1286OtherBLUE SHIELD PROVIDER #