Provider Demographics
NPI:1104336445
Name:BLUE SKY ANESTHESIA ASSOCIATES PLLC
Entity type:Organization
Organization Name:BLUE SKY ANESTHESIA ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THIBEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CRNA
Authorized Official - Phone:603-285-9171
Mailing Address - Street 1:109 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03835-3914
Mailing Address - Country:US
Mailing Address - Phone:603-285-9171
Mailing Address - Fax:
Practice Address - Street 1:109 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NH
Practice Address - Zip Code:03835-3914
Practice Address - Country:US
Practice Address - Phone:603-285-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048036-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty