Individual
KIRSTIN M PELLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
ERWIN RD, DURHAM, NC 27710-0001
(919) 684-8111
Mailing address
PO BOX 101737, ATLANTA, GA 30392-1737
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
140830
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140830
RN LICENSE
NC
Enumeration date
10/19/2006
Last updated
07/08/2007
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