Healthcare Provider Details

I. General information

NPI: 1841284510
Provider Name (Legal Business Name): CAROL A NORRIS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOMER AVE
CORTLAND NY
13045-1206
US

IV. Provider business mailing address

134 HOMER AVE POB 628
CORTLAND NY
13045-0628
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-7263
  • Fax: 607-753-7264
Mailing address:
  • Phone: 607-758-3752
  • Fax: 607-758-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number165495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: