Healthcare Provider Details

I. General information

NPI: 1891770566
Provider Name (Legal Business Name): KATHY T CRYSEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/30/2007
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

1217 ARBORETUM DR
LEWISVILLE NC
27023-8658
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-3069
  • Fax:
Mailing address:
  • Phone: 336-201-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number072701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: