Healthcare Provider Details

I. General information

NPI: 1033138441
Provider Name (Legal Business Name): ANJANA MENON YOUNG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 YADKIN ST
ALBEMARLE NC
28001-3441
US

IV. Provider business mailing address

409 CROOKED OAK DR
OAKBORO NC
28129-9600
US

V. Phone/Fax

Practice location:
  • Phone: 980-323-4590
  • Fax: 980-323-8269
Mailing address:
  • Phone: 704-485-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number161797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: