Healthcare Provider Details

I. General information

NPI: 1912211145
Provider Name (Legal Business Name): SHELLY LYNN COLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-3800
US

IV. Provider business mailing address

PO BOX 714960
COLUMBUS OH
43271-4960
US

V. Phone/Fax

Practice location:
  • Phone: 434-244-2283
  • Fax:
Mailing address:
  • Phone: 800-800-1617
  • Fax: 866-759-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0224173662
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number56255
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: