Healthcare Provider Details

I. General information

NPI: 1548733793
Provider Name (Legal Business Name): MICHELLE ELIZABETH JUMP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD STE 100
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

10830 SMITHERS CT
HENRICO VA
23238-3491
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6258
  • Fax: 804-673-1038
Mailing address:
  • Phone: 302-448-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024177219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: