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1861458648

NPI Code Detail

MEDICARE: MR. PETER GANUN CRNA

MEDICARE: MR. PETER GANUN 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	163W00000X	Registered Nurse	181130	NC
2	367500000X	Certified Registered Nurse Anesthetist	181130	NC
3	367500000X	Certified Registered Nurse Anesthetist	306	NC

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
2	562014989	OTHER	NC	TRICARE

General Provider Information

NPI Number	:	1861458648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER GANUN CRNA

Provider Business Mailing Address
First Line	:	214 BATES RETREAT
Second Line	:	MIDDLE POINT VILLAGE
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-2474
Country	:	US
Telephone Number	:	910-270-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 WESTERN BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6338
Country	:	US
Telephone Number	:	910-577-2471
Fax Number	:	910-577-2634

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	02/01/2022

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Directions to “ MR. PETER GANUN CRNA” Practice Location

Language	Start Address	Practice Location

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