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General NPI Number Information
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NPI Number | 1093766164
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Entity Type | Individual
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Provider Name | BRIAN MATTHEW CARROLL CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1144 N ROAD ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-3353
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Country | US
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Telephone | 252-335-0531
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BLANCHARD HTS
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City | GROTON
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State | NY
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Zip | 13073-1220
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Country | US
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Telephone | 607-898-5269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 198874
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 470
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License Number State | NC
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