Provider Demographics
NPI:1992359905
Name:COOMER, ANDREA MAGRI (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAGRI
Last Name:COOMER
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 1:1924 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3779
Mailing Address - Country:US
Mailing Address - Phone:774-266-3444
Mailing Address - Fax:
Practice Address - Street 1:1924 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3779
Practice Address - Country:US
Practice Address - Phone:774-266-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC282847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered