| NPI | 1245502913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI ELAINE RUNYON Managed Care Coordinator 540-855-5139 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA OH667) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2019-09-30 |