Provider Demographics
NPI:1437216504
Name:WELLER, CECILIA DINKINS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:DINKINS
Last Name:WELLER
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 1:144 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3882
Mailing Address - Country:US
Mailing Address - Phone:704-825-1762
Mailing Address - Fax:
Practice Address - Street 1:1622 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4939
Practice Address - Country:US
Practice Address - Phone:704-482-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060558367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050637Medicaid
NC8050637Medicaid
NC2626598BMedicare ID - Type Unspecified