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NPI Code Detail

MEDICARE: LEE ANN SPEED CRNA

MEDICARE: LEE ANN SPEED 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
1163W00000XRegistered Nurse0001151641VA
2367500000XCertified Registered Nurse Anesthetist0024165672VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q41733AOTHERVAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053315796
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE ANN SPEED CRNA
Provider Business Mailing Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number : 540-918-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 08/31/2016

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Directions to “ LEE ANN SPEED CRNA” Practice Location

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