Provider Demographics
NPI:1770552697
Name:MOURAS, VIRGINIA N (CRNA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:N
Last Name:MOURAS
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:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0314
Mailing Address - Country:US
Mailing Address - Phone:907-883-9839
Mailing Address - Fax:907-883-9839
Practice Address - Street 1:CORNER BOREALIS AND EAST D STREET
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0314
Practice Address - Country:US
Practice Address - Phone:907-883-9839
Practice Address - Fax:907-883-9839
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA00209367500000X
KS55129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200371520AMedicaid
KS144923OtherBCBS OF KS
KSP00056232OtherRR MEDICARE GROUP CQ2302
KS144923Medicare PIN
KSP00056232OtherRR MEDICARE GROUP CQ2302