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NPI Code Detail

MEDICARE: MARILEE WALTER CRNA

MEDICARE: MARILEE WALTER 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 Anesthetist0024165966VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982609913
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILEE WALTER CRNA
Provider Business Mailing Address
First Line : 1504 SANTA ROSA RD
Second Line : RM 206
City : RICHMOND
State : VA
Zip : 23229-5109
Country : US
Telephone Number : 804-288-4453
Fax Number : 804-288-1621
Provider Business Practice Location Address
First Line : 1602 SKIPWITH RD
Second Line :
City : RICHMOND
State : VA
Zip : 23229-5205
Country : US
Telephone Number : 804-289-4937
Fax Number : 804-565-6600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/25/2013

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