Healthcare Provider Details

I. General information

NPI: 1972062578
Provider Name (Legal Business Name): NICOLE MARIE TSCHUDI ANGLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE TSCHUDI CRNA

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

2511 DELANEY AVE
WILMINGTON NC
28403-6003
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8000
  • Fax:
Mailing address:
  • Phone: 910-667-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number266426
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: