Healthcare Provider Details

I. General information

NPI: 1629346309
Provider Name (Legal Business Name): ANNA M VANCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

700 COLLINS DR
TRAVIS AFB CA
94535-2427
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-4463
  • Fax:
Mailing address:
  • Phone: 210-748-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001305382
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024182486
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number597771
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: