MEDICARE: MRS. SUZANNA B GREENWELL MSN-CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN71210	TN
2	367500000X	Certified Registered Nurse Anesthetist	APN11316	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4129312	OTHER	TN	BC/BS TN - INTEGRATED
2	4232052	OTHER	TN	BC/BS OF TN - SAC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4243114	OTHER	TN	BC/BS OF TN - SAS
5	4236357	OTHER	TN	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1033147269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNA B GREENWELL MSN-CRNA

Provider Business Mailing Address
First Line	:	PO BOX 291264
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37229-1264
Country	:	US
Telephone Number	:	615-620-2320
Fax Number	:	615-620-2323

Provider Business Practice Location Address
First Line	:	175 HOSPITAL DR
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1617
Country	:	US
Telephone Number	:	731-593-6300
Fax Number	:	615-620-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/17/2018

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