Healthcare Provider Details

I. General information

NPI: 1194123646
Provider Name (Legal Business Name): MARK ALLEN STRUTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N ELM ST
GREENSBORO NC
27455-2596
US

IV. Provider business mailing address

255 LAKEWALK DR
REIDSVILLE NC
27320-9447
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-1833
  • Fax:
Mailing address:
  • Phone: 937-367-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6733
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: