Healthcare Provider Details

I. General information

NPI: 1063742484
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MCCARTNEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WEST ST
CARTHAGE NY
13619-9703
US

IV. Provider business mailing address

106 MOUNTAINWOOD DR
HENDERSONVILLE TN
37075-2923
US

V. Phone/Fax

Practice location:
  • Phone: 315-952-5650
  • Fax:
Mailing address:
  • Phone: 423-202-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number625196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: