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General NPI Number Information
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NPI Number | 1558761411
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Entity Type | Individual
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Provider Name | TAMARA LYNNE EDIE CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 2655 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2280
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Country | US
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Telephone | 866-347-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 LANDRY AVE
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City | HARAHAN
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State | LA
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Zip | 70123-3716
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Country | US
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Telephone | 504-250-2750
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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 | AP08006
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License Number State | LA
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