Provider Demographics
NPI:1235109091
Name:CARROLL, CHERYL S (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 VIRGINIA RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9668
Practice Address - Country:US
Practice Address - Phone:252-482-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123639367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050145Medicaid
VA8940479Medicaid
VA8940487Medicaid
VA8940495Medicaid
VA8940452Medicaid
VA8940461Medicaid
VA8940495Medicaid
VA8940461Medicaid