Individual
AUTUMN SAMANTHA LONGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
273 WINE CIR, BLOUNTVILLE, TN 37617-4315
(423) 416-1678
Mailing address
DEPT 888618, KNOXVILLE, TN 37995-0001
(423) 915-9942
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024177740
VA
Other
Enumeration date
06/20/2019
Last updated
12/15/2023
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