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General NPI Number Information
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NPI Number | 1932530698
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Entity Type | Individual
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Provider Name | AMANDA LEN MARTIN CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | VALLEY ANESTHESIA 4504 STARKEY RD
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-345-3556
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Fax |
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Provider Business Mailing Address
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Address Line | 7893 CEDAR EDGE RD
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-521-9439
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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 | 1
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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 | 0024171450
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License Number State | VA
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