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General NPI Number Information
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NPI Number | 1922881713
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Entity Type | Individual
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Provider Name | AMANDA SHEA TERWILLIGER CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 803 POPLAR ST
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City | MURRAY
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State | KY
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Zip | 42071-2432
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Country | US
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Telephone | 270-762-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 198 MULLINS LN
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City | BETHEL SPRINGS
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State | TN
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Zip | 38315-4465
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Country | US
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Telephone | 731-439-3379
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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 | 4008692
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 231249
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License Number State | TN
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