Provider Demographics
NPI:1225094139
Name:MIQUEL, ANA MARIA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:MARIA
Last Name:MIQUEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ANA
Other - Middle Name:MARIA
Other - Last Name:BROOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3305 GROUSE HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4959
Mailing Address - Country:US
Mailing Address - Phone:336-293-8063
Mailing Address - Fax:
Practice Address - Street 1:1240 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-585-1770
Practice Address - Fax:336-585-1771
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30554367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562014989OtherTRICARE
NC6907604Medicaid
NC6907604Medicaid