Healthcare Provider Details

I. General information

NPI: 1457535197
Provider Name (Legal Business Name): ROCHUNDA PELMORE LEWIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MATTHEWS TOWNSHIP PKWY
MATTHEWS NC
28105-4656
US

IV. Provider business mailing address

1500 MATTHEWS TOWNSHIP PKWY
MATTHEWS NC
28105-4656
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-6500
  • Fax: 336-768-9019
Mailing address:
  • Phone: 704-384-6500
  • Fax: 336-768-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: