Provider Demographics
NPI:1841247301
Name:AGOSTINI, CAROL (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:AGOSTINI
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:690 CANTON ST
Mailing Address - Street 2:STE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2324
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-236-7430
Practice Address - Fax:508-236-7446
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA210100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA1174Medicare PIN