Healthcare Provider Details

I. General information

NPI: 1538230842
Provider Name (Legal Business Name): ROBYN L. LYEMANCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

4400 GOLF ACRES DR SUITE A
CHARLOTTE NC
28208-5968
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-8983
  • Fax:
Mailing address:
  • Phone: 704-512-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0115265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: