Provider Demographics
NPI:1538139217
Name:MCDERMOTT, BARBARA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:MCDERMOTT
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 1:554 GRANDE MANOR CT UNIT 204
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4387
Mailing Address - Country:US
Mailing Address - Phone:919-824-3793
Mailing Address - Fax:
Practice Address - Street 1:554 GRANDE MANOR CT UNIT 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4387
Practice Address - Country:US
Practice Address - Phone:919-824-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126796367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050866Medicaid
FL308207500Medicaid
GA933940889AMedicaid
FL308207500Medicaid
FLAF491ZMedicare PIN
GA43BBCWBMedicare PIN