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General NPI Number Information
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NPI Number | 1306248604
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Entity Type | Individual
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Provider Name | MARY SANDRA LATHREM CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 256 FORT SANDERS WEST BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37922-3355
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Country | US
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Telephone | 859-699-9534
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Fax |
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Provider Business Mailing Address
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Address Line | 940 BOB KIRBY RD
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City | KNOXVILLE
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State | TN
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Zip | 37923-1910
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Country | US
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Telephone | 859-699-9534
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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 | 3008752
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN9284688
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 38874
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License Number State | TN
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