=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275611972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET SUSAN CODY CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 958 US HWY 64 EAST
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-4135
-----------------------------------------------------
Fax | 252-793-7747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 707 958 US HWY 64 EAST
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962-0707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-4135
-----------------------------------------------------
Fax | 252-793-7747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 037109
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------