Healthcare Provider Details

I. General information

NPI: 1265462535
Provider Name (Legal Business Name): ANGELA BRITT WHITTEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2700 WAYNE MEMORIAL DR
GOLDSBORO NC
27534-9494
US

IV. Provider business mailing address

133 ADLER LN
GOLDSBORO NC
27530-5516
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-6065
  • Fax:
Mailing address:
  • Phone: 919-734-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number082262
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: