Healthcare Provider Details

I. General information

NPI: 1437538378
Provider Name (Legal Business Name): ERICA LYNN GREEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA LYNN BELDEGREEN CRNA

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD
CHARLOTTE NC
28203-5866
US

IV. Provider business mailing address

2116 WILLOW MANOR RD
CHARLOTTE NC
28209-1502
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5206
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: