Individual
COFFEE BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-5023
(804) 828-2207
(804) 828-8300
Mailing address
PO BOX 780125, PHILADELPHIA, PA 19178-0125
(804) 922-4844
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001253399
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024174431
VA
Other
Enumeration date
01/25/2017
Last updated
10/15/2023
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