Provider Demographics
NPI:1629078209
Name:CULBERTSON, AUDREY L (CRNA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:CARROL AND TATE STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-883-8330
Mailing Address - Fax:276-889-4336
Practice Address - Street 1:CARROL AND TATE STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8330
Practice Address - Fax:276-889-4336
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166232207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
006224R87Medicare ID - Type Unspecified