Healthcare Provider Details

I. General information

NPI: 1407839889
Provider Name (Legal Business Name): LINDA HARWI TRIMBLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER DEPT. OF ANESTHESIA - MEDICAL CENTER BOULEVARD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

207 W BESSEMER AVE
GREENSBORO NC
27401-1403
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-2755
  • Fax:
Mailing address:
  • Phone: 336-274-0720
  • Fax: 336-274-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number058164
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: