Healthcare Provider Details

I. General information

NPI: 1194713974
Provider Name (Legal Business Name): LORENE DAVIDSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY STE 100
RICHMOND VA
23235-1968
US

IV. Provider business mailing address

5855 BREMO RD SUITE 100 NORTH
RICHMOND VA
23226-1926
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4500
  • Fax: 804-545-0758
Mailing address:
  • Phone: 804-288-6258
  • Fax: 804-282-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001082689
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024082689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: