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General NPI Number Information
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NPI Number | 1073795795
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Entity Type | Individual
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Provider Name | JOSHUA LYNWOOD BAXTER CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 808 BARRINGTON PLACE DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4390
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Country | US
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Telephone | 256-504-2789
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Fax |
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Provider Business Mailing Address
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Address Line | 808 BARRINGTON PLACE DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4390
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Country | US
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Telephone | 256-504-2789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 078147
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License Number State | TN
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