Healthcare Provider Details

I. General information

NPI: 1568766327
Provider Name (Legal Business Name): ELISABETH F HALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 KIRBY PARKWAY SUITE 330
MEMPHIS TN
38120
US

IV. Provider business mailing address

PO BOX 171306
MEMPHIS TN
38187
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-5846
  • Fax: 901-726-4827
Mailing address:
  • Phone: 800-809-2106
  • Fax: 334-386-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR871937
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: