Healthcare Provider Details

I. General information

NPI: 1578621785
Provider Name (Legal Business Name): WAYNE WINFREE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 HOSPITAL DR
CARTHAGE TN
37030-1083
US

IV. Provider business mailing address

PO BOX 291704
NASHVILLE TN
37229-1704
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: