Provider Demographics
NPI:1811141468
Name:BERRONG, MISTI LEANN (CRNA)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:LEANN
Last Name:BERRONG
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 1:2085 FRONTIS PLAZA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-277-1065
Mailing Address - Fax:336-277-9274
Practice Address - Street 1:3333 SILAS CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-651-8100
Practice Address - Fax:336-277-9445
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC081856367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered