Healthcare Provider Details

I. General information

NPI: 1730285958
Provider Name (Legal Business Name): MILDRED D FLORY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S 17TH ST
WILMINGTON NC
28401-6443
US

IV. Provider business mailing address

1801 S 17TH ST
WILMINGTON NC
28401-6443
US

V. Phone/Fax

Practice location:
  • Phone: 910-798-8922
  • Fax: 910-798-8923
Mailing address:
  • Phone: 910-798-8922
  • Fax: 910-798-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: