Healthcare Provider Details

I. General information

NPI: 1255772240
Provider Name (Legal Business Name): OREN SKY PETRANKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRYAR CREEK DR
CARY NC
27519-5622
US

IV. Provider business mailing address

3950 FAIRSTED DR APT 625
RALEIGH NC
27612-4585
US

V. Phone/Fax

Practice location:
  • Phone: 917-543-8666
  • Fax:
Mailing address:
  • Phone: 917-543-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number599888-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number304183
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5875
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: