1033147269 NPI number — MRS. SUZANNA B GREENWELL MSN-CRNA

Table of content: MRS. SUZANNA B GREENWELL MSN-CRNA (NPI 1033147269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033147269 NPI number — MRS. SUZANNA B GREENWELL MSN-CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENWELL
Provider First Name:
SUZANNA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN-CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033147269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38320-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-593-6300
Provider Business Practice Location Address Fax Number:
615-620-2323
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN71210 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APN11316 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4129312 . This is a "BC/BS TN - INTEGRATED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4232052 . This is a "BC/BS OF TN - SAC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3624344 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4243114 . This is a "BC/BS OF TN - SAS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4236357 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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