Healthcare Provider Details

I. General information

NPI: 1144298761
Provider Name (Legal Business Name): THERESA C BONNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 22ND AVE N
NASHVILLE TN
37203-1842
US

IV. Provider business mailing address

324 22ND AVE N
NASHVILLE TN
37203-1842
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-4401
  • Fax: 615-327-9612
Mailing address:
  • Phone: 615-329-4401
  • Fax: 615-327-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberGAA-CRNA001054
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number108041
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number001054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: