Provider Demographics
NPI:1023003795
Name:HENSLEIGH, CHARLES EUGENE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EUGENE
Last Name:HENSLEIGH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-0877
Mailing Address - Country:US
Mailing Address - Phone:757-934-9334
Mailing Address - Fax:757-923-9648
Practice Address - Street 1:2000 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-934-9334
Practice Address - Fax:757-923-9648
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024077570367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023003795OtherNPI
VA430000252Medicare PIN