Healthcare Provider Details

I. General information

NPI: 1568893410
Provider Name (Legal Business Name): BRIAN WIENHOFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE # 1300
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

1495 ANNE BURRAS AVE
HAMPTON VA
23665-2410
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-7315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number209011253
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024194691
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041327984
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: