Healthcare Provider Details

I. General information

NPI: 1477836344
Provider Name (Legal Business Name): ERIC C CULP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE SUITE 300
FAIRFAX VA
22033
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-2687
  • Fax: 570-340-3487
Mailing address:
  • Phone: 703-295-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN587102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: