Healthcare Provider Details

I. General information

NPI: 1356719868
Provider Name (Legal Business Name): KRISTEN VUYOVICH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST
ELIZABETH CITY NC
27909-3473
US

IV. Provider business mailing address

1144N ROAD ST
ELIZABETH CITY NC
27909-3473
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-0531
  • Fax:
Mailing address:
  • Phone: 252-384-2610
  • Fax: 252-338-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number243628
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number108840
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: