Healthcare Provider Details

I. General information

NPI: 1598833261
Provider Name (Legal Business Name): MICHELLE LYNN CAUSEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

301 COUNTRY VALLEY CT
APEX NC
27502-8097
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-3034
  • Fax:
Mailing address:
  • Phone: 919-363-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number163807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: