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NPI Code Detail

MEDICARE: LEA ELLEN WELBORN CRNA

MEDICARE: LEA ELLEN WELBORN CRNA
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
1367500000XCertified Registered Nurse AnesthetistR861834MS

General Provider Information

NPI Number : 1487684767
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEA ELLEN WELBORN CRNA
Provider Business Mailing Address
First Line : 2020 EXETER RD
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-3945
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1208 OFFICE PARK DR
Second Line :
City : OXFORD
State : MS
Zip : 38655-3597
Country : US
Telephone Number : 662-234-9888
Fax Number : 662-281-8927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 09/19/2022

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Directions to “ LEA ELLEN WELBORN CRNA” Practice Location

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