Provider Demographics
NPI:1609881481
Name:SWILLEY, BENNIE F (CRNA)
Entity Type:Individual
Prefix:
First Name:BENNIE
Middle Name:F
Last Name:SWILLEY
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 1:1801 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6443
Mailing Address - Country:US
Mailing Address - Phone:910-798-8922
Mailing Address - Fax:910-798-8923
Practice Address - Street 1:1801 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6443
Practice Address - Country:US
Practice Address - Phone:910-798-8922
Practice Address - Fax:910-798-8923
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC034533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare ID - Type UnspecifiedPROVIDER NO.