Healthcare Provider Details

I. General information

NPI: 1538408869
Provider Name (Legal Business Name): TERRI EVERETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

68 S SERVICE RD
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3789
  • Fax: 703-295-9369
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001241991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: