Individual
MICHAEL PHILIP ULMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
Mailing address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AANA 31399
TN
367500000X
Certified Registered Nurse Anesthetist
APN 9624
TN
367500000X
Certified Registered Nurse Anesthetist
RN 83185
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010270111
—
VA
01
—
3058690
BLUE CROSS OF TENNESSEE
—
05
—
3608926
—
TN
05
—
74012550
—
KY
Enumeration date
01/18/2006
Last updated
07/27/2021
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