Healthcare Provider Details

I. General information

NPI: 1114220217
Provider Name (Legal Business Name): LESLIE E VIAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

410 N CEDAR BLUFF RD STE 300
KNOXVILLE TN
37923-3632
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax: 423-624-6355
Mailing address:
  • Phone: 865-342-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number192049
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN17371
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: