Healthcare Provider Details

I. General information

NPI: 1982258430
Provider Name (Legal Business Name): ALEXANDER NOEL MANNING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

3749 SIGNET DR
WINSTON SALEM NC
27101
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2207
  • Fax: 804-828-8300
Mailing address:
  • Phone: 732-233-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR14902900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00957600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6756
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024188708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: