Provider Demographics
NPI:1972647816
Name:MYSLENSKI, JULIE (CRNA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MYSLENSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-2317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2224
Practice Address - Country:US
Practice Address - Phone:401-490-2130
Practice Address - Fax:401-490-2141
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244499163W00000X
MARN244499367500000X
CT003269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA1020Medicare ID - Type Unspecified