Healthcare Provider Details

I. General information

NPI: 1568999191
Provider Name (Legal Business Name): ELIZABETH ANN BADMAEV CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 04/20/2022
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

81 CAMDEN CIR APT 102
SCOTT DEPOT WV
25560-5610
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5432
  • Fax:
Mailing address:
  • Phone: 304-395-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number71020
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: