Individual
STACY LEE FAVAZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Mailing address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2272463
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2272463
MA
Other
Enumeration date
05/29/2015
Last updated
07/16/2024
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