Healthcare Provider Details

I. General information

NPI: 1659619336
Provider Name (Legal Business Name): RANI MABLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW CCC BLDG, LOWER LEVEL, DEPARTMENT OF ANESTHESIA
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

11979 BARREL COOPER CT
RESTON VA
20191-2320
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-6680
  • Fax:
Mailing address:
  • Phone: 702-336-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1019673
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: