Healthcare Provider Details

I. General information

NPI: 1780649160
Provider Name (Legal Business Name): JOSEPH MICHAEL MOREL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MOUNT PELIA RD
MARTIN TN
38237-3811
US

IV. Provider business mailing address

204 POPLAR ST
MARTIN TN
38237-3121
US

V. Phone/Fax

Practice location:
  • Phone: 731-588-0001
  • Fax: 731-587-2775
Mailing address:
  • Phone: 731-588-0001
  • Fax: 731-587-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 43009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: