Individual
GARY NILSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
455 TOLLGATE RD, WARWICK, RI 02886-2759
(401) 738-1516
Mailing address
690 CANTON STREET, SUITE 325, WESTWOOD, MA 02090-2329
(781) 407-7713
(781) 451-0998
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA20382
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NR40830
—
RI
Enumeration date
10/27/2006
Last updated
12/06/2007
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