Provider Demographics
NPI:1043792385
Name:VAN ARSDALE, GRACE (CRNA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:VAN ARSDALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1827 CORCORAN ST NW APT C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7607
Mailing Address - Country:US
Mailing Address - Phone:610-304-5935
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1029956367500000X
VA0024184039367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered