Healthcare Provider Details

I. General information

NPI: 1104822824
Provider Name (Legal Business Name): JOAN THORNE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 N LAUDERDALE ST # MS 0515 C/O DANA CANNON
MEMPHIS TN
38105-2729
US

IV. Provider business mailing address

332 N LAUDERDALE ST
MEMPHIS TN
38105-2794
US

V. Phone/Fax

Practice location:
  • Phone: 901-495-3006
  • Fax: 901-495-3842
Mailing address:
  • Phone: 901-495-3006
  • Fax: 901-495-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number66483
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: