Provider Demographics
NPI:1780655415
Name:PAINTER, VIRGINA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:VIRGINA
Middle Name:LEE
Last Name:PAINTER
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 1:176 HIGHWAY TT
Mailing Address - Street 2:
Mailing Address - City:MARTHASVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63357-2228
Mailing Address - Country:US
Mailing Address - Phone:636-239-8090
Mailing Address - Fax:
Practice Address - Street 1:901 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3127
Practice Address - Country:US
Practice Address - Phone:636-239-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS036413367500000X
MO036413367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004013305Medicare ID - Type Unspecified
MO831884998Medicare PIN