Provider Demographics
NPI:1578802427
Name:COUNTOURIOTIS, MICHELLE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:COUNTOURIOTIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:RIPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD MCXC-COD CREDENTIALS
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 105999367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered