MEDICARE: ELIZABETH HOLBEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	367500000X	Certified Registered Nurse Anesthetist	0024186435	VA

General Provider Information

NPI Number	:	1003563628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HOLBEN CRNA

Provider Business Mailing Address
First Line	:	3509 KENSINGTON AVE APT 3
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-2138
Country	:	US
Telephone Number	:	614-477-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 KENSINGTON AVE APT 3
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-2138
Country	:	US
Telephone Number	:	614-477-3507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	03/29/2023

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