1174580450 NPI number — MRS. AMY G FERRARA CRNA

Table of content: MRS. AMY G FERRARA CRNA (NPI 1174580450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174580450 NPI number — MRS. AMY G FERRARA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRARA
Provider First Name:
AMY
Provider Middle Name:
G
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRETT
Provider Other First Name:
AMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174580450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-384-4239
Provider Business Mailing Address Fax Number:
704-384-5636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HAWTHORNE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-384-4239
Provider Business Practice Location Address Fax Number:
704-384-5636
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  054762 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NAN437 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8052061 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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