Provider Demographics
NPI:1932121910
Name:STABILE-SIMON, ROSE ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:ROSE ANN
Middle Name:
Last Name:STABILE-SIMON
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 1:2000 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-3449
Mailing Address - Country:US
Mailing Address - Phone:252-633-8640
Mailing Address - Fax:252-636-5376
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8640
Practice Address - Fax:252-636-5376
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014MROtherNC BCBS GROUP BILLING #
NC8051346Medicaid
NC2600363BMedicare ID - Type UnspecifiedMEDICARE PART B, CIGNA
NC8051346Medicaid
NC014MROtherNC BCBS GROUP BILLING #