Healthcare Provider Details

I. General information

NPI: 1023307303
Provider Name (Legal Business Name): JESSIE L. ORBAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 HARRIMAN ST
GREAT FALLS VA
22066-2500
US

IV. Provider business mailing address

934 HARRIMAN ST
GREAT FALLS VA
22066-2500
US

V. Phone/Fax

Practice location:
  • Phone: 610-972-9859
  • Fax:
Mailing address:
  • Phone: 610-972-9859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024179296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: