Provider Demographics
NPI:1083637557
Name:BARRELL, MARCY ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:ANN
Last Name:BARRELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 WILSON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8469
Mailing Address - Country:US
Mailing Address - Phone:704-660-7923
Mailing Address - Fax:
Practice Address - Street 1:277 WILSON LAKE RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8469
Practice Address - Country:US
Practice Address - Phone:704-660-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC020860367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050017Medicaid
NC260830AMedicare ID - Type Unspecified
WI211050122Medicare Oscar/Certification