Provider Demographics
NPI:1801848775
Name:WANZER, ELIZABETH RAE (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAE
Last Name:WANZER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:RAE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:307 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4719
Mailing Address - Country:US
Mailing Address - Phone:252-335-0531
Mailing Address - Fax:252-384-4871
Practice Address - Street 1:1144 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3353
Practice Address - Country:US
Practice Address - Phone:252-335-0531
Practice Address - Fax:252-384-4871
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC049565367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2603508AMedicare PIN