Provider Demographics
NPI:1881844181
Name:CLENDENIN, SARAH BETH (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:CLENDENIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:GREATHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:MID-ATLANTIC ANESTHESIA CONSULTANTS, LLC
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:MID-ATLANTIC ANESTHESIA CONSULTANTS, LLC AT CAMC TEAYS
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN64772-CRNA367500000X
WV080077367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ39077COtherMEDICARE PTAN
WV9333201OtherMEDICARE GROUP
WV0207026000OtherMEDICAID GROUP