Healthcare Provider Details

I. General information

NPI: 1619942133
Provider Name (Legal Business Name): GLENN B. GUARIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

PO BOX 603366
CHARLOTTE NC
28260-3366
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-2325
  • Fax:
Mailing address:
  • Phone: 240-566-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number279991
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: