MEDICARE: SHIRLEY DIANE DAVIS 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	048627	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760413942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY DIANE DAVIS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 601549
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1549
Country	:	US
Telephone Number	:	704-384-4000
Fax Number	:	704-384-5636

Provider Business Practice Location Address
First Line	:	10030 GILEAD RD
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7545
Country	:	US
Telephone Number	:	704-316-4875
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/29/2025

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