Provider Demographics
NPI:1508191941
Name:STOWELL, BROOKE AMELIA SMITH (CRNA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:AMELIA SMITH
Last Name:STOWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6616
Mailing Address - Country:US
Mailing Address - Phone:207-973-4519
Mailing Address - Fax:
Practice Address - Street 1:141 N MAIN ST
Practice Address - Street 2:#205
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2011
Practice Address - Country:US
Practice Address - Phone:207-992-4032
Practice Address - Fax:207-992-4132
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER049759163W00000X
SCR97153163W00000X
GARN196287163W00000X
MEAA093048367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered