Provider Demographics
NPI:1053616664
Name:LAREW, AMANDA RENEE (CRNA, APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:LAREW
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 FRENCH QUARTERS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 FRENCH QUARTERS DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2284
Practice Address - Country:US
Practice Address - Phone:304-376-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV67755367500000X
WV086554367500000X
WVAPRN67755-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9333201OtherMEDICARE GROUP
WV0207026000OtherGROUP MEDICAID
WV9333201OtherMEDICARE GROUP
WV9333201OtherMEDICARE GROUP