Healthcare Provider Details

I. General information

NPI: 1588197701
Provider Name (Legal Business Name): JOHN-MICHAEL NOAH YOUNG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEDICAL CENTER PKWY SUITE 330
MURFREESBORO TN
37129-2567
US

IV. Provider business mailing address

1800 MEDICAL CENTER PKWY SUITE 330
MURFREESBORO TN
37129-2567
US

V. Phone/Fax

Practice location:
  • Phone: 615-396-4464
  • Fax: 615-396-6748
Mailing address:
  • Phone: 615-396-4464
  • Fax: 615-396-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22536
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: