1649351412 NPI number — MRS. ELIZABETH JAMES CASTRESANA CRNA

Table of content: MRS. ELIZABETH JAMES CASTRESANA CRNA (NPI 1649351412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649351412 NPI number — MRS. ELIZABETH JAMES CASTRESANA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRESANA
Provider First Name:
ELIZABETH
Provider Middle Name:
JAMES
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649351412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 MCBRIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30907-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-228-5521
Provider Business Mailing Address Fax Number:
706-228-5521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SAINT JOSEPH HOSPITAL
Provider Second Line Business Practice Location Address:
2260 WRIGHTSBORO ROAD
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-481-7609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2006

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:  RN086983 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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