Provider Demographics
NPI:1639328669
Name:CAUDLE, ROBERT JOSHUA (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSHUA
Last Name:CAUDLE
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-2755
Mailing Address - Fax:336-713-0660
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-2755
Practice Address - Fax:336-713-0660
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCCNA 081859282NC0060X
NC193112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access