Healthcare Provider Details

I. General information

NPI: 1366712135
Provider Name (Legal Business Name): SHANA LANE MEHOLCHICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 70 E
DICKSON TN
37055-2080
US

IV. Provider business mailing address

110 29TH AVE N STE 202
NASHVILLE TN
37203-1448
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4304
  • Fax:
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number88130
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: