1164430963 NPI number — MRS. EMILY N STREVELS CRNA

Table of content: MRS. EMILY N STREVELS CRNA (NPI 1164430963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164430963 NPI number — MRS. EMILY N STREVELS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STREVELS
Provider First Name:
EMILY
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRUMAN
Provider Other First Name:
EMILY
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164430963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 TRANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-6053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-588-0880
Provider Business Mailing Address Fax Number:
865-584-3111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 ALCOA HWY
Provider Second Line Business Practice Location Address:
BOX U109
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-305-9220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006

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:  RN132420 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: APN11853 , 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: 073439 , 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: 3635711 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4114363 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".