Individual
LACI R MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
Mailing address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
(615) 327-7940
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN13027
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009913624
—
AL
05
—
3600186
—
TN
01
—
4171082
BCBS
TN
05
—
7100030110
—
KY
Enumeration date
01/09/2008
Last updated
04/04/2012
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