Healthcare Provider Details

I. General information

NPI: 1306229323
Provider Name (Legal Business Name): SUZANNA AYASH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

4925 HERKIMER ST
ANNANDALE VA
22003-5139
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8640
  • Fax:
Mailing address:
  • Phone: 703-655-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1030379
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: