Provider Demographics
NPI:1194713974
Name:DAVIDSON, LORENE (CRNA)
Entity type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 100 NORTH
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1926
Mailing Address - Country:US
Mailing Address - Phone:804-288-6258
Mailing Address - Fax:804-282-9921
Practice Address - Street 1:8700 STONY POINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1968
Practice Address - Country:US
Practice Address - Phone:804-775-4500
Practice Address - Fax:804-545-0758
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001082689163W00000X
VA0024082689367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9554611Medicaid