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General NPI Number Information
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NPI Number | 1912980376
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Entity Type | Individual
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Provider Name | VANCE BILLY MCVAY JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER DEPT OF ANESTHESIA MEDICAL CENTER BOULEVARD
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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 | 7264 STYERS CROSSING LN
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City | CLEMMONS
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State | NC
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Zip | 27012-8101
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Country | US
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Telephone | 336-716-3069
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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 | 114966
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License Number State | NC
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