Healthcare Provider Details

I. General information

NPI: 1255345088
Provider Name (Legal Business Name): CHARLOTTE MILLS HARRISON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 HEMBY LANE GASTROENTEROLOGY EAST, P.A.
GREENVILLE NC
27834
US

IV. Provider business mailing address

2700 WAYNE MEMORIAL DR
GOLDSBORO NC
27534-9494
US

V. Phone/Fax

Practice location:
  • Phone: 252-551-3000
  • Fax: 252-551-3100
Mailing address:
  • Phone: 919-731-6068
  • Fax: 919-731-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: