Healthcare Provider Details

I. General information

NPI: 1104004860
Provider Name (Legal Business Name): MARISA ELEK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2198 UNC HOSPITALS CB# 7010
CHAPEL HILL NC
27599-7010
US

IV. Provider business mailing address

PO BOX 271647
SALT LAKE CITY UT
84127-1647
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-5136
  • Fax: 984-974-4873
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number161988-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: