| NPI | 1932641313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MICHELLE WILSON Director 865-985-7114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2026-02-11 |