Provider Demographics
NPI:1093760043
Name:WREN, KATHLEEN R (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:WREN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2479 PONKAN SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6415
Mailing Address - Country:US
Mailing Address - Phone:336-716-1415
Mailing Address - Fax:336-716-1412
Practice Address - Street 1:MEDICAL CENTER DRIVE
Practice Address - Street 2:NURSE ANESTHESIA PROGRAM
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:407-303-9331
Practice Address - Fax:407-303-9578
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP03921367500000X
FLARNP 9263820367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered