Provider Demographics
NPI:1568610517
Name:CRUTHIRDS, DANETTE FAYE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:FAYE
Last Name:CRUTHIRDS
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 1:310 TRAMORE CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-3550
Mailing Address - Country:US
Mailing Address - Phone:703-430-4490
Mailing Address - Fax:
Practice Address - Street 1:310 TRAMORE CT
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-3550
Practice Address - Country:US
Practice Address - Phone:703-430-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI45228367500000X
KS1491127091367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered