Basic Information
| Provider Information | |||||||||
| NPI: | 1023131596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIARELLO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417 | ||||||||
| Address2: | |||||||||
| City: | BOOTHBAY HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045380417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076332121 | ||||||||
| FaxNumber: | 2076331224 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 SAINT ANDREWS LN | ||||||||
| Address2: | |||||||||
| City: | BOOTHBAY HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045381731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076332121 | ||||||||
| FaxNumber: | 2076331224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | ME8423 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.