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NPI Code Detail

MEDICARE: SANDRA SMITH CRNA

MEDICARE: SANDRA SMITH 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
1367500000XCertified Registered Nurse Anesthetist0024156957VA

General Provider Information

NPI Number : 1689636847
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA SMITH CRNA
Provider Business Mailing Address
First Line : DEPT 1041 PO BOX 740209
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0209
Country : US
Telephone Number : 941-360-1566
Fax Number : 941-358-9818
Provider Business Practice Location Address
First Line : 801 S ADAMS ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-5133
Country : US
Telephone Number : 804-862-5000
Fax Number : 804-862-5948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 07/08/2007

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Directions to “ SANDRA SMITH CRNA” Practice Location

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