Individual
PETER DEFOREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
908 QUAIL LN, SALEM, VA 24153-7716
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001-161021
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024-161021
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8934495
—
VA
05
—
8934690
—
VA
05
—
8934703
—
VA
05
—
8934711
—
VA
05
—
8934720
—
VA
Enumeration date
04/25/2006
Last updated
05/06/2008
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