Healthcare Provider Details

I. General information

NPI: 1295728558
Provider Name (Legal Business Name): TERRY WINSTON ENGLISH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/15/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 TRUMPET SOUND CT
CLARKSVILLE MD
21029-1265
US

IV. Provider business mailing address

5900 TRUMPET SOUND CT
CLARKSVILLE MD
21029-1265
US

V. Phone/Fax

Practice location:
  • Phone: 919-618-2034
  • Fax: 410-730-3175
Mailing address:
  • Phone: 919-618-2034
  • Fax: 410-730-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number162683
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR200461
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: