Provider Demographics
NPI:1083643225
Name:ANNAM, NAYANA (CRNA)
Entity Type:Individual
Prefix:
First Name:NAYANA
Middle Name:
Last Name:ANNAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NAYANA
Other - Middle Name:
Other - Last Name:KAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:207 OLD LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3428
Mailing Address - Country:US
Mailing Address - Phone:336-476-2586
Mailing Address - Fax:
Practice Address - Street 1:207 OLD LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3428
Practice Address - Country:US
Practice Address - Phone:336-476-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTEMP003513367500000X
NC36754367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052955Medicaid
NC8052955Medicaid