Basic Information
| Provider Information | |||||||||
| NPI: | 1184985269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCARRA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARENO | ||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MARENO | ||||||||
| OtherFirstName: | NICOLE | ||||||||
| OtherMiddleName: | WHITNEY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25 MILO STREET | ||||||||
| Address2: | |||||||||
| City: | WEST NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024651011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624902551 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL - MAIN CAMPUS | ||||||||
| Address2: | 55 FRUIT STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN2329639 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 9273853 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.