Provider Demographics
NPI:1306857743
Name:SAYRE, JULIE ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SAYRE
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:PO BOX 711841
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-1841
Mailing Address - Country:US
Mailing Address - Phone:304-346-7313
Mailing Address - Fax:304-744-9802
Practice Address - Street 1:100 PEYTON WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8767
Practice Address - Country:US
Practice Address - Phone:304-346-7313
Practice Address - Fax:304-744-9802
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV075648367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006305Medicaid
WV8237713Medicare PIN