Provider Demographics
NPI:1821213489
Name:EGAN, FLORENCE M (CRNA)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:MASSACHUSETTS ANESTHESIA CORP.
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:978-887-5415
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST.
Practice Address - Street 2:C/O MA ANESTHESIA CORP.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:781-341-8269
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208830367500000X
MARN208830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0639Medicare PIN
MAJX2805Medicare PIN
MAJX2757Medicare PIN