Individual
MS. TRACI PAGE HANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
151906
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
070424
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052050
—
NC
05
—
NAN498
—
SC
Enumeration date
09/26/2005
Last updated
10/28/2020
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