MEDICARE: CARLA ANNETTE RILLING CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	129292	NC

General Provider Information

NPI Number	:	1053560672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA ANNETTE RILLING CRNA

Provider Business Mailing Address
First Line	:	201 E. GROVER STREET
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3917
Country	:	US
Telephone Number	:	980-487-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 GOLF ACRES DR STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5906
Country	:	US
Telephone Number	:	704-512-6428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	06/09/2017

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