Individual
MS. PHYLLIS LAMARR MCCUTCHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BOULEVARD, WINSTON SALEM, NC 27157-0001
(336) 713-5360
Mailing address
4355 WOODBOURNE DR, CLEMMONS, NC 27012-9132
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
072138
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090810
RN LICENSE
NC
05
—
8052113
—
NC
Enumeration date
05/04/2006
Last updated
01/27/2012
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