Healthcare Provider Details

I. General information

NPI: 1407025703
Provider Name (Legal Business Name): TERREASA LORRAINE FARMER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HAMLET AVE
HAMLET NC
28345-4522
US

IV. Provider business mailing address

PO BOX 402136
ATLANTA GA
30384-2136
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-8245
  • Fax: 910-205-8164
Mailing address:
  • Phone: 910-997-2463
  • Fax: 910-997-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number133500
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: