Healthcare Provider Details

I. General information

NPI: 1437163722
Provider Name (Legal Business Name): MICHELLE SUE VINCENT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FIRST VLG
PINEHURST NC
28374-8725
US

IV. Provider business mailing address

PO BOX 5628
PINEHURST NC
28374-5628
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-5000
  • Fax:
Mailing address:
  • Phone: 910-315-9811
  • Fax: 910-235-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number070441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: