Healthcare Provider Details

I. General information

NPI: 1528420825
Provider Name (Legal Business Name): EMILY BREIGHNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY BOX U-109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

2204 WILBORN AVE
SOUTH BOSTON VA
24592-1645
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax:
Mailing address:
  • Phone: 865-305-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number180292
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number21954
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: