Healthcare Provider Details

I. General information

NPI: 1306807151
Provider Name (Legal Business Name): ALECIA ANNE HARRISON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CREEKVIEW DR
CLAYTON NC
27520-9191
US

IV. Provider business mailing address

1812 CREEKVIEW DR
CLAYTON NC
27520-9191
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-0102
  • Fax:
Mailing address:
  • Phone: 919-359-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number090152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: