Provider Demographics
NPI:1134351265
Name:QUE, ANNE M (CRNA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:QUE
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 1:128 FORT WASHINGTON AVE
Mailing Address - Street 2:4K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 FORT WASHINGTON AVE
Practice Address - Street 2:4K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4721
Practice Address - Country:US
Practice Address - Phone:617-803-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY573900163W00000X
MA2282119367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse