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MRS. KORIE L AGUDELO CRNA

>> Nurse Anesthetist, Certified Registered >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1891094165

Individual Registrant:
MRS. KORIE L AGUDELO CRNA
Gender: F
Not Sole Proprietor

Location and contact information for practice:
380 HOSPITAL DR SUITE 410 MACON, GA 31217 US
Tel: 478-746-5644  Fax: --

Contact information for business:
PO BOX 2564  MACON, GA 31203-2565 US
Tel: 478-746-5644  Fax: 478-745-4849

Registration Information:
NPI: 1891094165
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered
GARN159841

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
TRICARE580628385GA01
003113553IGA05
003113553JGA05
WELLCARE637585GA01
003116613CGA05
003116613AGA05




HEALTH CARE JOBS GA - Page 1



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