Healthcare Provider Details

I. General information

NPI: 1063425338
Provider Name (Legal Business Name): WILLIAM LYTLE RESSLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL DR
LURAY VA
22835-1000
US

IV. Provider business mailing address

499 MONT VIEW LN
LURAY VA
22835-3548
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-4561
  • Fax: 540-743-9560
Mailing address:
  • Phone: 540-743-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001047073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: