Provider Demographics
NPI:1083637631
Name:OLDENBURG, SUE C (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:C
Last Name:OLDENBURG
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 1:2105 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1309
Mailing Address - Country:US
Mailing Address - Phone:252-523-8161
Mailing Address - Fax:252-523-8161
Practice Address - Street 1:2105 EMERSON RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-1309
Practice Address - Country:US
Practice Address - Phone:252-523-8161
Practice Address - Fax:252-523-8161
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC083143367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050622Medicaid
NCP00679668OtherRAILROAD MEDICARE
NCP00679668OtherRAILROAD MEDICARE
NC260218HMedicare PIN