MEDICARE: MARVIN E EARLY 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	0024165272	VA

General Provider Information

NPI Number	:	1669476529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN E EARLY CRNA

Provider Business Mailing Address
First Line	:	10800 MIDLOTHIAN TPKE
Second Line	:	SUITE 265
City	:	RICHMOND
State	:	VA
Zip	:	23235-4724
Country	:	US
Telephone Number	:	804-594-2622
Fax Number	:	804-594-0915

Provider Business Practice Location Address
First Line	:	1401 JOHNSTON WILLIS DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-4730
Country	:	US
Telephone Number	:	804-594-2622
Fax Number	:	804-594-0915

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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