Healthcare Provider Details

I. General information

NPI: 1689626954
Provider Name (Legal Business Name): TRACI MUNDY BURKE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST
ELIZABETH CITY NC
27909-3353
US

IV. Provider business mailing address

26 JARNAUL AVE
ASHEVILLE NC
28804-2249
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-0531
  • Fax:
Mailing address:
  • Phone: 828-242-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number128100
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: