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General NPI Number Information
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NPI Number | 1841231412
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Entity Type | Individual
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Provider Name | LISA RIEKER CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | MEDICAL CENTER BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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Country | US
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Telephone | 336-716-3069
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 WILLOW WOODS WAY
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City | WINSTON SALEM
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State | NC
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Zip | 27104-1226
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Country | US
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Telephone | 336-760-9601
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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 | 133107
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License Number State | NC
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