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General NPI Number Information
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NPI Number | 1245533009
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Entity Type | Individual
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Provider Name | TALISHA NICOLE PEAY MIDDLETON CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 720 E MOREHEAD ST STE 201
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City | CHARLOTTE
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State | NC
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Zip | 28202-2704
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Country | US
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Telephone | 704-355-2147
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 DUNFIELD CT
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City | CHARLOTTE
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State | NC
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Zip | 28269-8182
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Country | US
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Telephone | 704-517-7558
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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 | 171838
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License Number State | NC
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