Healthcare Provider Details

I. General information

NPI: 1407829880
Provider Name (Legal Business Name): CYNTHIA J DONATELLI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RANDOLPH RD
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

8635 LINDHOLM DR APT F
HUNTERSVILLE NC
28078-1878
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-4000
  • Fax:
Mailing address:
  • Phone: 704-987-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN293439L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: