Provider Demographics
NPI:1437163722
Name:VINCENT, MICHELLE SUE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUE
Last Name:VINCENT
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 5628
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-5628
Mailing Address - Country:US
Mailing Address - Phone:910-315-9811
Mailing Address - Fax:910-235-0985
Practice Address - Street 1:10 FIRST VLG
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8725
Practice Address - Country:US
Practice Address - Phone:910-235-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070441367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered