Individual
SAMUEL L COUILLARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
550 FORT LOUDOUN MEDICAL CENTER DR, LENOIR CITY, TN 37772-5673
(952) 442-9770
Mailing address
233 W 1ST ST, WACONIA, MN 55387-1302
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN43073
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3633144
—
TN
01
—
4072021
BLUE CROSS OF TENNESSEE
TN
Enumeration date
10/05/2005
Last updated
07/08/2007
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