Provider Demographics
NPI:1457333072
Name:ANDERSON, OLENA GROCE IV (CRNA)
Entity type:Individual
Prefix:MRS
First Name:OLENA
Middle Name:GROCE
Last Name:ANDERSON
Suffix:IV
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 1:2410 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5404
Mailing Address - Country:US
Mailing Address - Phone:336-716-3069
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
Practice Address - Street 2:MEDICAL CENTER BOULEVARD ANESTHESIA DEPARTMENT
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3069
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC031353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050210Medicaid
NC260988Medicare ID - Type Unspecified