Provider Demographics
NPI:1063750354
Name:COUSINS, ANNE P (DNPA, CRNA)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:P
Last Name:COUSINS
Suffix:
Gender:F
Credentials:DNPA, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-6249
Mailing Address - Country:US
Mailing Address - Phone:479-430-4080
Mailing Address - Fax:
Practice Address - Street 1:3221 BERGEN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-6249
Practice Address - Country:US
Practice Address - Phone:870-535-7457
Practice Address - Fax:870-535-2522
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR092738163W00000X
FL9322361163W00000X
ARC002954367500000X
NM61353367500000X
VA0024176530367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AH34OtherBLUE CROSS BLUE SHIELD
AR1063750354Medicaid
ARP01475050OtherRAILROAD MEDICARE
AR205201001Medicaid