Healthcare Provider Details

I. General information

NPI: 1992743199
Provider Name (Legal Business Name): WANDA K MURRAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA ANN KNOTT

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 FRANKLIN FARM RD STE 100
HERNDON VA
20171-4095
US

IV. Provider business mailing address

3100 SPRING FOREST RD STE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5206
  • Fax:
Mailing address:
  • Phone: 919-873-9533
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704166237
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024165955
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number51114
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: