Provider Demographics
NPI:1417104407
Name:MICHAEL, DAVID CHRISTOPHER (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:MALISA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6320 CHADFORD DR
Mailing Address - Street 2:APT 2003
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7104
Mailing Address - Country:US
Mailing Address - Phone:919-376-7085
Mailing Address - Fax:
Practice Address - Street 1:250 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-535-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189534367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered