Basic Information
| Provider Information | |||||||||
| NPI: | 1568448827 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GREEN | ||||||||
| FirstName: | ALANA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST RIVER DR 5TH FLOOR | ||||||||
| Address2: | MEDICAL ANESTHESIOLOGY ASSOCIATES PC | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061087301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824133 | ||||||||
| FaxNumber: | 8602890746 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 TRAP FALLS RD | ||||||||
| Address2: | SUITE 414 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064847623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039297353 | ||||||||
| FaxNumber: | 2039290756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 09/24/2014 | ||||||||
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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 | 367H00000X | 000377 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant | 367500000X | 377 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 004081725 | 05 | CT | MEDICAID |