Healthcare Provider Details

I. General information

NPI: 1134424401
Provider Name (Legal Business Name): KATRINA LYNETTE CHEEK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOMACK ARMY MEDICAL CTR
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2302 YORKSHIRE DR
GREENSBORO NC
27406-9403
US

V. Phone/Fax

Practice location:
  • Phone: 910-970-6323
  • Fax:
Mailing address:
  • Phone: 336-254-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number203654
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: