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NPI Code Detail

MEDICARE: MR. DAVID CHRISTOPHER MICHAEL CRNA

MEDICARE: MR. DAVID CHRISTOPHER MICHAEL 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
1367500000XCertified Registered Nurse Anesthetist189534NC

General Provider Information

NPI Number : 1417104407
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID CHRISTOPHER MICHAEL CRNA
Provider Business Mailing Address
First Line : 6320 CHADFORD DR
Second Line : APT 2003
City : RALEIGH
State : NC
Zip : 27612-7104
Country : US
Telephone Number : 919-376-7085
Fax Number :
Provider Business Practice Location Address
First Line : 250 SMITH CHURCH RD
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4914
Country : US
Telephone Number : 252-535-8437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2008
Last Update Date : 05/31/2026

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