Individual
AMANDA FAIRCLOTH WARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1250 E MARSHALL ST, ANESTHESIOLOGY CRNA, RICHMOND, VA 23298-5051
(804) 628-6990
(804) 628-6932
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 628-6990
(804) 628-6932
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024167211
VA
367500000X
Certified Registered Nurse Anesthetist
557126
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00459772
MEDICARE RAILROAD
VA
Enumeration date
01/26/2006
Last updated
10/28/2020
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