Healthcare Provider Details

I. General information

NPI: 1962666214
Provider Name (Legal Business Name): ELIZABETH GRIFFITH MYRICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MCDONALD

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 KIRBY PKWY STE 330
MEMPHIS TN
38120-4398
US

IV. Provider business mailing address

PO BOX 171306
MEMPHIS TN
38187-1306
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-5846
  • Fax: 901-726-4827
Mailing address:
  • Phone: 901-725-5846
  • Fax: 901-726-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number123088
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC02723CRNA
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: