Provider Demographics
NPI:1730127077
Name:SCHNEIDER, TIMOTHY L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:L
Last Name:SCHNEIDER
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 1:87 MCGREGOR ST
Mailing Address - Street 2:STE. 1400
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3765
Mailing Address - Country:US
Mailing Address - Phone:603-647-9325
Mailing Address - Fax:603-647-2453
Practice Address - Street 1:87 MCGREGOR ST
Practice Address - Street 2:STE. 1400
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-647-9325
Practice Address - Fax:603-647-2453
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056071-23-11367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1689OtherBCBS
FL302785600Medicaid
FLG1689ZMedicare ID - Type Unspecified
NH000548601Medicare PIN