Healthcare Provider Details

I. General information

NPI: 1841387610
Provider Name (Legal Business Name): MICHELLE MARIE GATES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S MAIN ST ANESTHESIA
BLACKSBURG VA
24060-7017
US

IV. Provider business mailing address

PO BOX 13888
ROANOKE VA
24038-3888
US

V. Phone/Fax

Practice location:
  • Phone: 540-953-5374
  • Fax:
Mailing address:
  • Phone: 540-953-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166787
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: