Healthcare Provider Details

I. General information

NPI: 1841680006
Provider Name (Legal Business Name): LAURA EDWARDS-STAVRIDES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 NORTH BATTLEFIELD BOULEVARD
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

1644 FLAMMARION DR
VIRGINIA BEACH VA
23454-6908
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-8121
  • Fax:
Mailing address:
  • Phone: 757-618-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001199335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: