Provider Demographics
NPI:1558431056
Name:MUCKLER, VIRGINIA C (CRNA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:MUCKLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:CHRISTINE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNA
Mailing Address - Street 1:3643 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2702
Mailing Address - Country:US
Mailing Address - Phone:919-470-6193
Mailing Address - Fax:919-477-1931
Practice Address - Street 1:3643 N ROXBORO RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-470-6193
Practice Address - Fax:919-477-1931
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC154339163W00000X, 367500000X
NC054473367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051669Medicaid
NC2603874Medicare ID - Type Unspecified