Provider Demographics
NPI:1730144411
Name:FOOSANER, CRAIG ROBERT (CRNA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ROBERT
Last Name:FOOSANER
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 1:312 DEVONPORT RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7876
Mailing Address - Country:US
Mailing Address - Phone:704-839-1372
Mailing Address - Fax:
Practice Address - Street 1:312 DEVONPORT RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-7876
Practice Address - Country:US
Practice Address - Phone:704-839-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC097277367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051792Medicaid
NC2620695JMedicare PIN