Healthcare Provider Details

I. General information

NPI: 1487621793
Provider Name (Legal Business Name): TONI MARIE DEMARCO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 CARROLLTON CROSSING DR
KERNERSVILLE NC
27284-4047
US

IV. Provider business mailing address

1393 CARROLLTON CROSSING DR
KERNERSVILLE NC
27284-4047
US

V. Phone/Fax

Practice location:
  • Phone: 336-423-0215
  • Fax: 800-264-8472
Mailing address:
  • Phone: 336-423-0215
  • Fax: 800-264-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2010037213
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024168603
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704137811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: