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NPI Code Detail

MEDICARE: MR. KOUDAHIN LATEVI LAWSON CRNA

MEDICARE: MR. KOUDAHIN LATEVI LAWSON CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0200XCritical Care Medicine Registered Nurse0001240679VA
2367500000XCertified Registered Nurse Anesthetist0024170381VA

General Provider Information

NPI Number : 1356694814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KOUDAHIN LATEVI LAWSON CRNA
Provider Business Mailing Address
First Line : 121 CALEDON CT
Second Line : 2
City : STEPHENS CITY
State : VA
Zip : 22655-3542
Country : US
Telephone Number : 704-241-9441
Fax Number :
Provider Business Practice Location Address
First Line : 1840 AMHERST ST
Second Line :
City : WINCHESTER
State : VA
Zip : 22601-2808
Country : US
Telephone Number : 540-536-8875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2012
Last Update Date : 04/30/2026

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