Provider Demographics
NPI:1962582551
Name:LINDSEY, PHILIP EUGENE (CRNA)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:EUGENE
Last Name:LINDSEY
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 1:1307 SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4160
Mailing Address - Country:US
Mailing Address - Phone:252-247-4348
Mailing Address - Fax:
Practice Address - Street 1:1307 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4160
Practice Address - Country:US
Practice Address - Phone:252-247-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC099865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA102884Medicare PIN
NC260707Medicare ID - Type Unspecified