Healthcare Provider Details

I. General information

NPI: 1386633873
Provider Name (Legal Business Name): TORI ELIZABETH PEARCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MDOS/SGOSA MISAWA AB
APO AP
96319
JP

IV. Provider business mailing address

PSC 76 BOX 7924
APO AP
96319
JP

V. Phone/Fax

Practice location:
  • Phone: 11-813-1176
  • Fax:
Mailing address:
  • Phone: 11-813-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD-073216
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: