Healthcare Provider Details

I. General information

NPI: 1194789107
Provider Name (Legal Business Name): TERESA KOLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 ROCK LANDING DR
NEWPORT NEWS VA
23606-4425
US

IV. Provider business mailing address

2212 SOUVERAIN LN
VIRGINIA BEACH VA
23454-7407
US

V. Phone/Fax

Practice location:
  • Phone: 757-591-2260
  • Fax:
Mailing address:
  • Phone: 757-481-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024035404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: