Provider Demographics
NPI:1023017910
Name:LAW, ANITA COLEMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:COLEMAN
Last Name:LAW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2726
Mailing Address - Country:US
Mailing Address - Phone:304-208-0707
Mailing Address - Fax:775-855-5424
Practice Address - Street 1:306 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3142
Practice Address - Country:US
Practice Address - Phone:304-255-3000
Practice Address - Fax:606-574-8013
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV041467367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0066810000Medicaid
WV0066810000Medicaid