Healthcare Provider Details

I. General information

NPI: 1609407683
Provider Name (Legal Business Name): ANNA ROSE LENCZYK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

1604 BALTIC AVE
VIRGINIA BEACH VA
23451-3426
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8121
  • Fax:
Mailing address:
  • Phone: 703-244-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024178784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: