Healthcare Provider Details

I. General information

NPI: 1316968878
Provider Name (Legal Business Name): MARY BETH DARDEN C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

2340 CAPE ARBOR DR
VIRGINIA BEACH VA
23451-1540
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-8121
  • Fax:
Mailing address:
  • Phone: 757-496-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024110486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: