Healthcare Provider Details

I. General information

NPI: 1265677397
Provider Name (Legal Business Name): LAKEVIEW ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0251
  • Fax: 757-934-9497
Mailing address:
  • Phone: 757-539-0251
  • Fax: 757-934-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CHRISTELLE S JOHNSON
Title or Position: CONTRACT ANALYST
Credential:
Phone: 757-934-9454