Provider Demographics
NPI:1447300116
Name:RAYNOR, CARLY AKULIS (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:AKULIS
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CARLY
Other - Middle Name:RENEE
Other - Last Name:AKULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 271647
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1647
Mailing Address - Country:US
Mailing Address - Phone:919-966-5136
Mailing Address - Fax:984-974-4873
Practice Address - Street 1:N2201 UNC HOSPITALS
Practice Address - Street 2:CB # 7010
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:919-966-4873
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC076211367500000X
LAAP05205367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024082Medicaid
LA$$$$$$$$$0OtherBC BS OF LA
LA3A470CQ68Medicare PIN
LA$$$$$$$$$0OtherBC BS OF LA