Provider Demographics
NPI:1366462624
Name:BLACK, PAULA (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-6282
Mailing Address - Fax:828-687-6285
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5272
Practice Address - Country:US
Practice Address - Phone:828-681-2113
Practice Address - Fax:828-681-2747
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2625957BMedicare PIN