Provider Demographics
NPI:1962490367
Name:HARRISON, NANCY J (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:HARRISON
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 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 100 NORTH
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1926
Mailing Address - Country:US
Mailing Address - Phone:804-288-6258
Mailing Address - Fax:804-282-9921
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-288-6258
Practice Address - Fax:804-282-9921
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001105509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003563H90Medicare ID - Type Unspecified