Healthcare Provider Details

I. General information

NPI: 1679562185
Provider Name (Legal Business Name): GLENN A BRIDGES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E MAIN ST
MORRISTOWN TN
37814-6632
US

IV. Provider business mailing address

PO BOX 1718
MORRISTOWN TN
37816-1718
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-5984
  • Fax: 423-581-0984
Mailing address:
  • Phone: 423-581-5987
  • Fax: 423-581-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN0000046238
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: