Healthcare Provider Details

I. General information

NPI: 1497710206
Provider Name (Legal Business Name): DENISE RAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 ROCK LANDING DR
NEWPORT NEWS VA
23606-4425
US

IV. Provider business mailing address

1548 COOL SPRING WAY
VIRGINIA BEACH VA
23464-8882
US

V. Phone/Fax

Practice location:
  • Phone: 757-591-2260
  • Fax:
Mailing address:
  • Phone: 757-467-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN304163L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: