MEDICARE: LYNDA M RADOW 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	0024071748	VA

General Provider Information

NPI Number	:	1770584609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA M RADOW CRNA

Provider Business Mailing Address
First Line	:	PO BOX 17978
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-7978
Country	:	US
Telephone Number	:	804-288-4453
Fax Number	:	804-288-1621

Provider Business Practice Location Address
First Line	:	7640 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4300
Country	:	US
Telephone Number	:	804-285-4763
Fax Number	:	804-288-8946

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/31/2012

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