Healthcare Provider Details

I. General information

NPI: 1013094648
Provider Name (Legal Business Name): CHRISTINA ANN KREWER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 PHYSICIANS DRIVE
JACKSON TN
38305
US

IV. Provider business mailing address

45 HUGHES DRIVE
JACKSON TN
38305-1510
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-5050
  • Fax:
Mailing address:
  • Phone: 731-256-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000156097
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: