Provider Demographics
NPI:1073721460
Name:FRANK, NICHOLAS LEWIS (CRNA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEWIS
Last Name:FRANK
Suffix:
Gender:M
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-0087
Mailing Address - Country:US
Mailing Address - Phone:252-207-2842
Mailing Address - Fax:
Practice Address - Street 1:128 WEIR POINT DR
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9409
Practice Address - Country:US
Practice Address - Phone:252-207-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051286Medicaid
NC8051286Medicaid