Healthcare Provider Details

I. General information

NPI: 1568513497
Provider Name (Legal Business Name): VALERIE SPELLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE FISHER CRNA

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MEDICAL PARK DR ANESTHESIA DEPT
BRIDGEPORT WV
26330-9006
US

IV. Provider business mailing address

327 MEDICAL PARK DR
BRIDGEPORT WV
26330-9006
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-1610
  • Fax: 681-342-1626
Mailing address:
  • Phone: 681-342-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number67615
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: