Healthcare Provider Details

I. General information

NPI: 1487567889
Provider Name (Legal Business Name): MONZERRAT PARAJELES FULLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

IV. Provider business mailing address

167 PINEWOOD LN
ADVANCE NC
27006-8778
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-5000
  • Fax:
Mailing address:
  • Phone: 336-971-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number159979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: