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General NPI Number Information
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NPI Number | 1861433609
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Entity Type | Individual
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Provider Name | CHARLES ASWELL CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 800 E DAWSON ST
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City | TYLER
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State | TX
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Zip | 75701-2036
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Country | US
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Telephone | 903-606-4522
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Fax | 865-541-2787
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Provider Business Mailing Address
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Address Line | PO BOX 841656
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City | DALLAS
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State | TX
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Zip | 75284-1656
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Country | US
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Telephone | 903-531-5000
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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 | 11871
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License Number State | TN
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