Healthcare Provider Details

I. General information

NPI: 1972032464
Provider Name (Legal Business Name): JIE LI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3357
US

IV. Provider business mailing address

PO BOX 2295
ASHEVILLE NC
28802-2295
US

V. Phone/Fax

Practice location:
  • Phone: 828-398-5244
  • Fax:
Mailing address:
  • Phone: 828-398-5244
  • Fax: 828-360-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number68483
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: