Healthcare Provider Details

I. General information

NPI: 1487932430
Provider Name (Legal Business Name): CHERISSA NICOLE WRENN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

134 BUSINESS PARK DR
VIRGINIA BEACH VA
23462-6523
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-0055
  • Fax: 757-473-0075
Mailing address:
  • Phone: 757-473-0055
  • Fax: 757-437-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9269683
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024170953
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: