Individual
PAMELA DORENE GRYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
(865) 541-2282
Mailing address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9012
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100022149
PHP TENNCARE
TN
05
—
3608375
—
TN
01
—
4020669
BLUE CROSS
TN
01
—
43006775
TRAVELRES MEDICARE
TN
Enumeration date
04/10/2006
Last updated
06/28/2010
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