Healthcare Provider Details

I. General information

NPI: 1194179473
Provider Name (Legal Business Name): PAIGE RAY BOTTOMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE VICTORIA RAY CRNA

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W ARLINGTON BLVD SUITE B
GREENVILLE NC
27834-3770
US

IV. Provider business mailing address

2080 W ARLINGTON BLVD SUITE B
GREENVILLE NC
27834-3770
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-2140
  • Fax: 252-689-6502
Mailing address:
  • Phone: 252-752-2140
  • Fax: 252-689-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5435
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: