Healthcare Provider Details

I. General information

NPI: 1568497618
Provider Name (Legal Business Name): NATASHA K FIJALKOWSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DRIVE
GASTONIA NC
28054
US

IV. Provider business mailing address

PO BOX 12845
GASTONIA NC
28052
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 704-834-2825
  • Fax: 704-866-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number049707
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: