Healthcare Provider Details

I. General information

NPI: 1043402043
Provider Name (Legal Business Name): MICHEAL HANCOCK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HOSPITAL RD
WINCHESTER TN
37398-2404
US

IV. Provider business mailing address

66 SUNRISE PARK
WINCHESTER TN
37398-2345
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-4061
  • Fax: 931-962-3343
Mailing address:
  • Phone: 931-962-4061
  • Fax: 931-962-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number13002
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: