Individual
AMELIA LISETTE FERNALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3100 SPRING FOREST RD, RALEIGH, NC 27616-2880
(919) 882-0705
(919) 873-9821
Mailing address
3100 SPRING FOREST RD, RALEIGH, NC 27616-2880
(919) 882-0705
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024168187
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457590523
—
VA
Enumeration date
02/13/2009
Last updated
09/30/2015
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