Provider Demographics
NPI:1083672844
Name:YEAGER, TERRY LEA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LEA
Last Name:YEAGER
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 1:1211 CEDAR CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523
Mailing Address - Country:US
Mailing Address - Phone:540-586-7312
Mailing Address - Fax:540-586-6833
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:FOURTH FLOOR, DEPT. OF ANESTHESIA
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-853-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024117302367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010201691Medicaid
VA008693C37Medicare PIN
430001854Medicare ID - Type Unspecified