Provider Demographics
NPI:1467424242
Name:GARVIN, NANCY (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GARVIN
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 1789
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24008
Mailing Address - Country:US
Mailing Address - Phone:540-855-5122
Mailing Address - Fax:540-342-4373
Practice Address - Street 1:438 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-378-5276
Practice Address - Fax:540-342-4373
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001052029163W00000X
VA0024052029363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010019249Medicaid
VA00W755L81Medicare ID - Type UnspecifiedRICHMOND MEDICARE
R62614Medicare UPIN
VA010019249Medicaid