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NPI Code Detail

MEDICARE: WAYNE FLATT CRNA

MEDICARE:   WAYNE  FLATT  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
1367500000XCertified Registered Nurse Anesthetist055138TN

Other Identifiers

General Provider Information

NPI Number : 1255331856
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE FLATT CRNA
Provider Business Mailing Address
First Line : 1817A MADISON ST
Second Line : STE 1
City : CLARKSVILLE
State : TN
Zip : 37043-2930
Country : US
Telephone Number : 931-551-1795
Fax Number :
Provider Business Practice Location Address
First Line : 651 DUNLOP LN
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-5015
Country : US
Telephone Number : 931-551-1795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 01/12/2009

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