MEDICARE: MRS. PAMELA SUE MURILLO 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	139043	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558345553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA SUE MURILLO CRNA

Provider Business Mailing Address
First Line	:	9509 LISSARA CAMP CT
Second Line	:
City	:	LEWISVILLE
State	:	NC
Zip	:	27023-9831
Country	:	US
Telephone Number	:	336-408-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 KIMEL PARK DR
Second Line	:	SUITE 120
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6984
Country	:	US
Telephone Number	:	336-768-3212
Fax Number	:	336-768-9019

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	03/30/2021

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