Healthcare Provider Details

I. General information

NPI: 1891734794
Provider Name (Legal Business Name): PETER WILLIAM JAMES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRVIEW DR
FRANKLIN VA
23851-1238
US

IV. Provider business mailing address

100 FAIRVIEW DR
FRANKLIN VA
23851-1238
US

V. Phone/Fax

Practice location:
  • Phone: 757-569-6277
  • Fax:
Mailing address:
  • Phone: 757-569-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001166014
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: