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General NPI Number Information
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NPI Number | 1396492815
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Entity Type | Individual
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Provider Name | KATHRYN ELYSE PEDERSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 7101 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 804-483-0745
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Fax |
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Provider Business Mailing Address
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Address Line | 4021 TRAYLOR DR
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City | RICHMOND
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State | VA
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Zip | 23235-1032
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Country | US
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Telephone | 434-277-1318
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001272996
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024186467
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License Number State | VA
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