Healthcare Provider Details

I. General information

NPI: 1346023181
Provider Name (Legal Business Name): VARSHA ANN THOTTANANIYIL SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 UNDERWOOD AVE # 804F
DURHAM NC
27701-2922
US

IV. Provider business mailing address

804 UNDERWOOD AVE # 804F
DURHAM NC
27701-2922
US

V. Phone/Fax

Practice location:
  • Phone: 862-213-6316
  • Fax:
Mailing address:
  • Phone: 862-213-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR227155000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: