Healthcare Provider Details

I. General information

NPI: 1003861840
Provider Name (Legal Business Name): JOANNA NORDLANDER HUCKABEE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FERNDALE BLVD
HIGH POINT NC
27262-4739
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-882-2567
  • Fax: 336-882-5466
Mailing address:
  • Phone: 336-713-0947
  • Fax: 336-882-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54240
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: