Healthcare Provider Details

I. General information

NPI: 1235453721
Provider Name (Legal Business Name): AMY CATHERINE DEMAREE LEWIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5588 TUCKER RD DEPARTMENT OF SURGERY
COLLEGEDALE TN
37315-1396
US

IV. Provider business mailing address

PO BOX 1355 5588 TUCKER RD
COLLEGEDALE TN
37315-1355
US

V. Phone/Fax

Practice location:
  • Phone: 423-504-5669
  • Fax: 419-783-4416
Mailing address:
  • Phone: 423-504-5669
  • Fax: 423-504-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000014687
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6372A
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN188003
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.11444-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: