Individual
VIVIAN PHILSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 HAWTHORNE LANE, CHARLOTTE, NC 28204
(704) 384-4239
(704) 384-5636
Mailing address
PO BOX 65849, CHARLOTTE, NC 28265
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
016678
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050796
—
NC
05
—
NAN053
—
SC
Enumeration date
05/10/2006
Last updated
07/08/2007
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