Healthcare Provider Details

I. General information

NPI: 1336685684
Provider Name (Legal Business Name): ELIZABETH ANN WATERBURY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S STERLING ST
MORGANTON NC
28655-4044
US

IV. Provider business mailing address

1762 BOST RD
MORGANTON NC
28655-7082
US

V. Phone/Fax

Practice location:
  • Phone: 507-429-0288
  • Fax:
Mailing address:
  • Phone: 507-429-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 185257-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6446
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: