Healthcare Provider Details

I. General information

NPI: 1063855633
Provider Name (Legal Business Name): KATHERINE LEHIGH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

2600 NE 20TH ST
POMPANO BEACH FL
33062-3023
US

V. Phone/Fax

Practice location:
  • Phone: 619-855-2620
  • Fax:
Mailing address:
  • Phone: 619-855-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9292378
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9292378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: