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NPI Code Detail

MEDICARE: MRS. MARY ELIZABETH DEVASHER CRNA,

MEDICARE: MRS. MARY ELIZABETH DEVASHER 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 Anesthetist18436TN

General Provider Information

NPI Number : 1629284179
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELIZABETH DEVASHER CRNA,
Provider Business Mailing Address
First Line : 1735 HUDSON RD
Second Line :
City : MADISON
State : TN
Zip : 37115-5705
Country : US
Telephone Number : 615-865-8664
Fax Number :
Provider Business Practice Location Address
First Line : 315 HOSPITAL DR
Second Line :
City : MADISON
State : TN
Zip : 37115-5030
Country : US
Telephone Number : 615-868-6503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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