Healthcare Provider Details

I. General information

NPI: 1093044463
Provider Name (Legal Business Name): PAMELA MICHELE SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA MICHELE LEWIS CRNA

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD SUITE 240
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

PO BOX 37090
BALTIMORE MD
21297-3090
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax: 703-295-9369
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-295-9369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: