Healthcare Provider Details

I. General information

NPI: 1235155201
Provider Name (Legal Business Name): WILLIAM SHREWSBERRY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 MCDOWELL ST
WELCH WV
24801-2029
US

IV. Provider business mailing address

PO BOX 634712
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-8461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number35607
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number39835
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: