Basic Information
| Provider Information | |||||||||
| NPI: | 1134232077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ANICIA | ||||||||
| MiddleName: | BOUTIN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 BILTON RD | ||||||||
| Address2: | |||||||||
| City: | SOMERS | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060711067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603069717 | ||||||||
| FaxNumber: | 8607634111 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 ST GEORGE RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137367463 | ||||||||
| FaxNumber: | 4137367466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 03/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 049381 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN197541 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.