Individual
JUDITH L. RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
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
367500000X
Certified Registered Nurse Anesthetist
Primary
033611
NC
367500000X
Certified Registered Nurse Anesthetist
058311
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260054Q
PSC MEDICARE PROVIDER #
NC
05
—
8050072
—
NC
Enumeration date
11/08/2005
Last updated
10/27/2020
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