Healthcare Provider Details

I. General information

NPI: 1104856137
Provider Name (Legal Business Name): LYNN FITZGERALD MACKSEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/04/2008
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

105 ARLEN PARK PL
HOLLY SPRINGS NC
27540-4001
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5645
  • Fax:
Mailing address:
  • Phone: 919-372-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number208226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: