Healthcare Provider Details

I. General information

NPI: 1235224924
Provider Name (Legal Business Name): LEVI SCOTTY MCGOWAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8000
  • 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 Number76108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: