MEDICARE: SHARLENE MALIA KONA 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	0024164665	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437251626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARLENE MALIA KONA CRNA

Provider Business Mailing Address
First Line	:	2216 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3625
Country	:	US
Telephone Number	:	434-249-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2216 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3625
Country	:	US
Telephone Number	:	434-249-5875
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/26/2021

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