1558341446 NPI number — MRS. CARRIE MICHELLE MULLER CRNA

Table of content: MRS. CARRIE MICHELLE MULLER CRNA (NPI 1558341446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558341446 NPI number — MRS. CARRIE MICHELLE MULLER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLER
Provider First Name:
CARRIE
Provider Middle Name:
MICHELLE
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:
FORRESTER
Provider Other First Name:
CARRIE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558341446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
828 HEALTHY WAY
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-7958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-495-8070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 HEALTHY WAY
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-7958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-495-8070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2006

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:  0024166944 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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