Healthcare Provider Details

I. General information

NPI: 1023078227
Provider Name (Legal Business Name): ANTHONY JULIUS CICHOCKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 WEST FRONT STREET
RICHLANDS VA
24641
US

IV. Provider business mailing address

2951 WEST FRONT STREET SUITE 3050
RICHLANDS VA
24641
US

V. Phone/Fax

Practice location:
  • Phone: 276-596-6160
  • Fax:
Mailing address:
  • Phone: 276-963-8504
  • Fax: 276-963-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001109176
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024109176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: