Healthcare Provider Details

I. General information

NPI: 1457506248
Provider Name (Legal Business Name): ERWIN SUMILLER ATILLO MSN - CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO ROAD SUITE 100 N.
RICHMOND VA
23226
US

IV. Provider business mailing address

6353A LOUDON AVE
ELKRIDGE MD
21075-5636
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6258
  • Fax:
Mailing address:
  • Phone: 240-841-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR160082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: