Healthcare Provider Details

I. General information

NPI: 1093096620
Provider Name (Legal Business Name): COLLEEN M CROUCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
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

10800 MIDLOTHIAN TPKE SUITE 265
NORTH CHESTERFIELD VA
23235-4724
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4500
  • Fax: 804-545-0758
Mailing address:
  • Phone: 804-594-2622
  • Fax: 804-594-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169796
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: