Basic Information
| Provider Information | |||||||||
| NPI: | 1023054426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUDD | ||||||||
| FirstName: | HOWARD | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 PAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522200 | ||||||||
| FaxNumber: | 6033265999 | ||||||||
| Practice Location | |||||||||
| Address1: | 59 PAGE HILL RD | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037523382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 039337-23-11 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | 039337-23-11 | NH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 363L00000X | 039337-21 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 30006944 | 05 | NH | MEDICAID |