Mary K Leavery, CRNA
Nurse Anesthetist, Certified Registered in Winston Salem, NC. Individual provider (NPI-1).
NPI number1063520005
StatusActive
Last updated in NPPESOct 28, 2020
Details
- NPI
- 1063520005
- Entity type
- Individual (NPI-1)
- Name
- Mary K Leavery
- Credential
- CRNA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 29, 2006
- Certification date
- Oct 28, 2020
- Last updated
- Oct 28, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 45453 | NC | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | 993 | SC | |
| 163W00000X | Registered Nurse | 360053-1 | NY |
Practice location
145 Kimel Park Dr Ste 120Winston Salem, NC 27103
Phone 336-768-3212 · Fax 336-768-9019
Mailing address
145 Kimel Park Dr Ste 120Winston Salem, NC 27103-6983
Phone 336-768-3212 · Fax 336-768-9019
Other practice locations
830 Washington St
Watertown, NY 13601-4034
Watertown, NY 13601-4034
Phone 315-785-4313 · Fax 315-779-5114
830 Washington St
Watertown, NY 13601-4034
Watertown, NY 13601-4034
Phone 315-785-4313 · Fax 315-779-5114
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