Healthcare Provider Details

I. General information

NPI: 1639451172
Provider Name (Legal Business Name): MEREDITH MYERS LONG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2011
Last Update Date: 09/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

347 S CHERRY ST
KERNERSVILLE NC
27284-2711
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2011
  • Fax:
Mailing address:
  • Phone: 336-497-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number088171
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: