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NPI Code Detail

MEDICARE: SAMUEL DURHAM RN, BSN, CCRN

MEDICARE: SAMUEL DURHAM RN, BSN, CCRN
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 Anesthetist250468TN

General Provider Information

NPI Number : 1912616707
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL DURHAM RN, BSN, CCRN
Provider Business Mailing Address
First Line : 315 HOSPITAL DR
Second Line :
City : MADISON
State : TN
Zip : 37115-5030
Country : US
Telephone Number : 615-732-7662
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 : 615-732-7662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2022
Last Update Date : 03/12/2026

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