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Individual

TAMARA N KISVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
155 MEMORIAL DR, PINEHURST, NC 28374-8710
(910) 715-1233
(910) 715-1943
Mailing address
PO BOX 8500, PINEHURST, NC 28374-8500
(910) 715-1233
(910) 715-1943

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR12177000
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
264121
NC
367500000X
Certified Registered Nurse Anesthetist
26NJ00354500
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
087590
AANA #
NJ
01
3873845000
AMERIHEALTH
NJ
01
P01005691
RAILROAD MEDICARE
NJ
Enumeration date
10/03/2011
Last updated
07/25/2014
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