Healthcare Provider Details

I. General information

NPI: 1225094139
Provider Name (Legal Business Name): ANA MARIA MIQUEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA MARIA BROOKER CRNA

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

3305 GROUSE HOLLOW CT
WINSTON SALEM NC
27106-4959
US

V. Phone/Fax

Practice location:
  • Phone: 336-585-1770
  • Fax: 336-585-1771
Mailing address:
  • Phone: 336-293-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: