Healthcare Provider Details

I. General information

NPI: 1508133117
Provider Name (Legal Business Name): CRAIG ANDREW VIRR RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 11/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6206 LONDON DR
AUSTIN TX
78745-3459
US

IV. Provider business mailing address

6206 LONDON DR
AUSTIN TX
78745-3459
US

V. Phone/Fax

Practice location:
  • Phone: 512-751-3405
  • Fax:
Mailing address:
  • Phone: 512-751-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number796250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: