Healthcare Provider Details

I. General information

NPI: 1821419177
Provider Name (Legal Business Name): PHAEDRIA THOROGOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 09/03/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

609 ROTUNDA ST
LYNCHBURG VA
24502-2073
US

V. Phone/Fax

Practice location:
  • Phone: 276-274-6137
  • Fax:
Mailing address:
  • Phone: 276-274-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024171526
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001207953
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: