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General NPI Number Information
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NPI Number | 1508588484
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Entity Type | Individual
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Provider Name | CHARLIE C AU CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 736 IRVING AVE
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City | SYRACUSE
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State | NY
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Zip | 13210-1602
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Country | US
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Telephone | 315-470-7646
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Fax | 315-470-7649
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Provider Business Mailing Address
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Address Line | 13219 DARWIN LN
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City | AUSTIN
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State | TX
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Zip | 78729-7494
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Country | US
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Telephone | 512-296-8709
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 935201
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License Number State | TX
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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 | 870259
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License Number State | NY
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