Individual
MARY SLOAN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3400 WAKE FOREST RD, RALEIGH, NC 27609-7317
(919) 954-3765
Mailing address
3100 SPRING FOREST RD, STE 130, RALEIGH, NC 27616-2880
(919) 882-0795
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
070096
NC
367500000X
Certified Registered Nurse Anesthetist
70096
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285602326
TRICARE
NC
05
—
1285602326
—
NC
05
—
3635537
—
TN
01
—
4113807
BCBS
TN
Enumeration date
03/14/2006
Last updated
04/28/2016
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