Provider Demographics
NPI:1710932983
Name:MYSLINSKI, GREGORY JOSEPH (CRNA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:MYSLINSKI
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 1:9304 RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:WHITAKERS
Mailing Address - State:NC
Mailing Address - Zip Code:27891-9603
Mailing Address - Country:US
Mailing Address - Phone:770-312-5876
Mailing Address - Fax:
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-447-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN531075367500000X
SC21557367500000X
NC496367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid