Healthcare Provider Details

I. General information

NPI: 1689208217
Provider Name (Legal Business Name): TANIA LALLI BARDSLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANIA ARAUJO LALLI

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

2016 ELVINGTON RD
JOHNS ISLAND SC
29455-8278
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7000
  • Fax:
Mailing address:
  • Phone: 623-262-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30303
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number286629
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: