MEDICARE: MR. TERRY WINSTON ENGLISH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	162683	NC
2	367500000X	Certified Registered Nurse Anesthetist	R200461	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36-4382785	OTHER	NC	TAX ID

General Provider Information

NPI Number	:	1295728558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY WINSTON ENGLISH CRNA

Provider Business Mailing Address
First Line	:	5900 TRUMPET SOUND CT
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1265
Country	:	US
Telephone Number	:	919-618-2034
Fax Number	:	410-730-3175

Provider Business Practice Location Address
First Line	:	5900 TRUMPET SOUND CT
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1265
Country	:	US
Telephone Number	:	919-618-2034
Fax Number	:	410-730-3175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/15/2022

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