Healthcare Provider Details

I. General information

NPI: 1831118298
Provider Name (Legal Business Name): SUZANNE SMITH MCLESTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 YADKIN ST
ALBEMARLE NC
28001-3441
US

IV. Provider business mailing address

31547 CEDAR LN
ALBEMARLE NC
28001-6402
US

V. Phone/Fax

Practice location:
  • Phone: 704-984-4469
  • Fax:
Mailing address:
  • Phone: 704-986-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number171442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: