Healthcare Provider Details

I. General information

NPI: 1023355500
Provider Name (Legal Business Name): MARY SHARON CLEMENTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 BUSINESS PARK DR
VIRGINIA BEACH VA
23462-6523
US

IV. Provider business mailing address

134 BUSINESS PARK DR
VIRGINIA BEACH VA
23462-6523
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-0055
  • Fax:
Mailing address:
  • Phone: 757-473-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024173141
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number798412
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number373878
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6447
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: