Healthcare Provider Details

I. General information

NPI: 1649351412
Provider Name (Legal Business Name): ELIZABETH JAMES CASTRESANA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAINT JOSEPH HOSPITAL 2260 WRIGHTSBORO ROAD
AUGUSTA GA
30904
US

IV. Provider business mailing address

158 MCBRIDE RD
MARTINEZ GA
30907-1665
US

V. Phone/Fax

Practice location:
  • Phone: 706-481-7609
  • Fax:
Mailing address:
  • Phone: 706-228-5521
  • Fax: 706-228-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN086983
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: