Healthcare Provider Details

I. General information

NPI: 1457537524
Provider Name (Legal Business Name): SETAREH BANAIAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW S-CCC
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

11760 SUNRISE VALLEY DR APT#302
RESTON VA
20191-1411
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8556
  • Fax: 202-444-8854
Mailing address:
  • Phone: 703-864-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024172809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: