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General NPI Number Information
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NPI Number | 1245336429
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Entity Type | Individual
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Provider Name | ANASTACIA D. BERSAMIN CRNA-P
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2800 GODWIN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-8038
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Country | US
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Telephone | 757-934-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 PHILMONT AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3717
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Country | US
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Telephone | 757-420-1216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 21946
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License Number State | VA
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