Provider Demographics
NPI:1124004197
Name:KANZLER, JOAN PACE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:PACE
Last Name:KANZLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ELIZABETH
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1349 PHEASANT LANE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-923-8179
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157
Practice Address - Country:US
Practice Address - Phone:336-713-2755
Practice Address - Fax:336-713-0660
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051697Medicaid
NC2604543Medicare PIN