Provider Demographics
NPI:1316985716
Name:SOUSA, JOSE (CRNA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SOUSA
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:99 E RIVER DR FL 5
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-0833
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:1312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3121
Practice Address - Country:US
Practice Address - Phone:203-756-6422
Practice Address - Fax:860-826-4992
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CTE50244163W00000X
CT1797367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT430000607Medicare PIN