Healthcare Provider Details

I. General information

NPI: 1336198787
Provider Name (Legal Business Name): SANDRA PENA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

PO BOX 751730
CHARLOTTE NC
28275-1730
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-5599
  • Fax: 336-716-3202
Mailing address:
  • Phone: 336-716-5599
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number055258
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2083
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: