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General NPI Number Information
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NPI Number | 1689660730
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Entity Type | Individual
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Provider Name | CARMEN SIOUX THOMAS CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 2825 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1018
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Country | US
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Telephone | 704-337-1647
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Fax | 704-377-5014
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Provider Business Mailing Address
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Address Line | 2080 W ARLINGTON BLVD SUITE B
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City | GREENVILLE
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State | NC
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Zip | 27834-3770
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Country | US
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Telephone | 252-752-2140
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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 | RN170518
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 164470
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 71440
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License Number State | NC
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