Healthcare Provider Details

I. General information

NPI: 1538408802
Provider Name (Legal Business Name): WILLIAM H TIPTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

3708 COTSWOLD TER
GREENSBORO NC
27410-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7793
  • Fax:
Mailing address:
  • Phone: 336-580-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number210178
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: