Healthcare Provider Details

I. General information

NPI: 1992359905
Provider Name (Legal Business Name): ANDREA MAGRI COOMER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 W ACADEMY ST
WINSTON SALEM NC
27103-3779
US

IV. Provider business mailing address

1924 W ACADEMY ST
WINSTON SALEM NC
27103-3779
US

V. Phone/Fax

Practice location:
  • Phone: 774-266-3444
  • Fax:
Mailing address:
  • Phone: 774-266-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6206
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number282847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: