MEDICARE: TERRY LASOME 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	367500000X	Certified Registered Nurse Anesthetist	0024166806	VA

General Provider Information

NPI Number	:	1255317434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY LASOME CRNA

Provider Business Mailing Address
First Line	:	2157 HARITHY DR
Second Line	:
City	:	DUNN LORING
State	:	VA
Zip	:	22027-1056
Country	:	US
Telephone Number	:	703-992-8841
Fax Number	:

Provider Business Practice Location Address
First Line	:	WALTER REED ARMY MEDICAL CENTER
Second Line	:	6900 GEORGIA AVE NW
City	:	WASHINGTON
State	:	DC
Zip	:	20307-0001
Country	:	US
Telephone Number	:	202-782-7580
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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