Healthcare Provider Details

I. General information

NPI: 1013295088
Provider Name (Legal Business Name): EUGENE LARRY WARPULA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GENE LARRY WARPULA CRNA

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 11/18/2011
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

PO BOX 535395
ATLANTA GA
30353-5321
US

V. Phone/Fax

Practice location:
  • Phone: 919-873-9533
  • Fax:
Mailing address:
  • Phone: 919-873-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number088366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: