Healthcare Provider Details

I. General information

NPI: 1841485935
Provider Name (Legal Business Name): LACEY LISS CHAVARRIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N ELM ST
HIGH POINT NC
27262-4331
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-6000
  • Fax: 336-878-6010
Mailing address:
  • Phone: 336-878-6000
  • Fax: 336-878-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181589
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number078220
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: