MEDICARE: SLEEP DEEP ANESTHESIA LLC

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	AP11163	VI

General Provider Information

NPI Number	:	1457716490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DEEP ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	5121 COTTON VALLEY SHORES
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	865-816-7244
Fax Number	:

Provider Business Practice Location Address
First Line	:	#4 PLOT 21 COTTON VALLEY SHORES
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	865-816-7244
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CRNA
Name	:	CHRISTI HOPKINS
Credential	:
Telephone Number	:	865-816-7244

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	03/18/2016

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