MEDICARE: DR. JILL SUZANNE DETTY OSWAKS DNSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APN0000010943	TN

General Provider Information

NPI Number	:	1417022021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL SUZANNE DETTY OSWAKS DNSC

Provider Business Mailing Address
First Line	:	9267 FOREST ISLAND DR
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3576
Country	:	US
Telephone Number	:	901-756-7128
Fax Number	:	901-756-7128

Provider Business Practice Location Address
First Line	:	9267 FOREST ISLAND DR
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3576
Country	:	US
Telephone Number	:	901-756-7128
Fax Number	:	901-756-7128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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