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General NPI Number Information
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NPI Number | 1942314117
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Entity Type | Individual
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Provider Name | EDWARD TEM CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 2750 GODWIN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-8036
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Country | US
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Telephone | 757-983-2010
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Fax | 757-983-2001
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Provider Business Mailing Address
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Address Line | 2080 W ARLINGTON BLVD STE B
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City | GREENVILLE
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State | NC
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Zip | 27834-3770
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Country | US
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Telephone | 252-752-2140
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Fax | 252-689-6502
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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 | 0001300998
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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 | 105555
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024181129
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License Number State | VA
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