Healthcare Provider Details

I. General information

NPI: 1518324037
Provider Name (Legal Business Name): SONJA O'SULLIVAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLINCH AVE
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

2 TRAP FALLS RD SUITE 414
SHELTON CT
06484-4616
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1111
  • Fax:
Mailing address:
  • Phone: 203-929-7353
  • Fax: 203-929-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number107689
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24560
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: