Provider Demographics
NPI:1578505541
Name:MEENACH, RICHARD LAMAR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAMAR
Last Name:MEENACH
Suffix:
Gender:M
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 78144
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27427-8144
Mailing Address - Country:US
Mailing Address - Phone:336-601-2653
Mailing Address - Fax:
Practice Address - Street 1:128 PEACHTREE LN
Practice Address - Street 2:SUITE B
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6782
Practice Address - Country:US
Practice Address - Phone:336-998-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC057134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered