Healthcare Provider Details

I. General information

NPI: 1467497388
Provider Name (Legal Business Name): GRAHAM N STANLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DR PLEASANT VALLEY HOSPITAL
POINT PLEASANT WV
25550
US

IV. Provider business mailing address

PO BOX 711841 MID- ATLANTIC ANESTHESIA CONSULTANTS
COLUMBUS OH
43271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-674-2403
  • Fax: 304-675-2240
Mailing address:
  • Phone: 304-346-9400
  • Fax: 304-720-8461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22005
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA00758
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number142485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: