Healthcare Provider Details

I. General information

NPI: 1053616664
Provider Name (Legal Business Name): AMANDA RENEE LAREW CRNA, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RENEE MAIER

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FRENCH QUARTERS DR
MORGANTOWN WV
26505-2284
US

IV. Provider business mailing address

2 FRENCH QUARTERS DR
MORGANTOWN WV
26505-2284
US

V. Phone/Fax

Practice location:
  • Phone: 304-376-7635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number67755
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086554
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN67755-CRNA
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: