Individual
MRS. TAMMIE D. CVENGROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
225 MEDICAL CENTER DR, SUITE 308, PADUCAH, KY 42003-7914
(270) 441-4750
(270) 441-4770
Mailing address
225 MEDICAL CENTER DR, SUITE 308, PADUCAH, KY 42003-7914
(270) 441-4750
(270) 441-4770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28205260A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
4765A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000382987
BCBS
—
05
—
74450750
—
KY
Enumeration date
10/03/2006
Last updated
09/23/2015
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