Provider Demographics
NPI:1104229129
Name:CORRIVEAU, LUC G (CRNA)
Entity type:Individual
Prefix:DR
First Name:LUC
Middle Name:G
Last Name:CORRIVEAU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3542
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:603-752-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA143059367500000X
NH060989-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered