Healthcare Provider Details

I. General information

NPI: 1083672844
Provider Name (Legal Business Name): TERRY LEA YEAGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE FOURTH FLOOR, DEPT. OF ANESTHESIA
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1211 CEDAR CREST DRIVE
BEDFORD VA
24523
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-0222
  • Fax:
Mailing address:
  • Phone: 540-586-7312
  • Fax: 540-586-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024117302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: