Provider Demographics
NPI:1174652242
Name:MACHADO, ALLISON RENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RENEE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:509 N BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-938-7019
Mailing Address - Fax:919-938-7957
Practice Address - Street 1:509 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7019
Practice Address - Fax:919-938-7957
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052466Medicaid
NC2610685Medicare PIN