Individual
KEVIN M PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
330 BROOKLINE AVE DEPT OF, BOSTON, MA 02215-5491
(617) 667-3110
Mailing address
330 BROOKLINE AVE DEPT OF, BOSTON, MA 02215-5491
(617) 667-3110
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2277331
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2277331
MA
Other
Enumeration date
02/27/2018
Last updated
09/19/2022
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