Individual
TIMOTHY A MUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
074797
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
035818
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578603718
TRICARE
NC
05
—
8050470
—
NC
01
—
P00343914
RAILROAD MEDICARE
NC
Enumeration date
02/07/2007
Last updated
10/11/2018
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