Healthcare Provider Details

I. General information

NPI: 1750395885
Provider Name (Legal Business Name): TERRI LEE BROTHERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 SHORE DR
SODDY DAISY TN
37379-3550
US

IV. Provider business mailing address

9940 SHORE DR
SODDY DAISY TN
37379-3550
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-2881
  • Fax: 423-843-3901
Mailing address:
  • Phone: 423-842-2881
  • Fax: 423-843-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009211
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: