Healthcare Provider Details

I. General information

NPI: 1144478637
Provider Name (Legal Business Name): ANNE VENABLE EDMUNDS HANSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 8TH ST. SW ROANOKE/ALLEGHENY HEALTH DEPARTMENT
ROANOKE VA
24016
US

IV. Provider business mailing address

900 BOWYER LANE
LEXINGTON VA
24450
US

V. Phone/Fax

Practice location:
  • Phone: 540-857-7600
  • Fax:
Mailing address:
  • Phone: 540-460-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101238838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: