MEDICARE: SUSAN MOYERS 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	367500000X	Certified Registered Nurse Anesthetist	044145	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3116123	OTHER	TN	BCBS NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932109832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MOYERS CRNA

Provider Business Mailing Address
First Line	:	124 TIRZAH ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3874
Country	:	US
Telephone Number	:	615-516-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 LEWISBURG PIKE
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5037
Country	:	US
Telephone Number	:	615-791-2360
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/07/2023

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