Individual
ROGER VANDYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
(846) 541-2787
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
10591
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100021702
PHP TENNCARE
TN
01
—
3037710
BLUE CROSS
TN
05
—
3602923
—
TN
01
—
430009525
MEDICARE TRAVELERS
TN
Enumeration date
06/10/2006
Last updated
06/28/2010
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