Healthcare Provider Details

I. General information

NPI: 1407158793
Provider Name (Legal Business Name): ANNE ELIZABETH CHURCH WHITE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNE ELIZABETH CHURCH CRNA

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 FARMINGTON DR
LEBANON TN
37087-8601
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-509-4711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16225
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: