Healthcare Provider Details

I. General information

NPI: 1932214459
Provider Name (Legal Business Name): JANELLE CALLAWAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

134 BUSINESS PARK DR
VIRGINIA BEACH VA
23462-6523
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8369
  • Fax:
Mailing address:
  • Phone: 757-473-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24116839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: