Healthcare Provider Details

I. General information

NPI: 1932109832
Provider Name (Legal Business Name): SUSAN MOYERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LEWISBURG PIKE
FRANKLIN TN
37064-5037
US

IV. Provider business mailing address

124 TIRZAH ST
LEBANON TN
37087-3874
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-2360
  • Fax:
Mailing address:
  • Phone: 615-516-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number044145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: