Provider Demographics
NPI:1043516644
Name:DECARLO, VALERIE MUMM (CRNA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:MUMM
Last Name:DECARLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:NICOLE
Other - Last Name:MUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6253 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:STALEY
Mailing Address - State:NC
Mailing Address - Zip Code:27355-8303
Mailing Address - Country:US
Mailing Address - Phone:843-697-6619
Mailing Address - Fax:
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246779367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered