Individual
MRS. SHANNON MARIE TEWES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
150 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 967-5000
Mailing address
425 LEWIS HARGETT CIR, LEXINGTON, KY 40503-3590
(859) 268-1030
(859) 269-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3007287
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0062978
—
OH
05
—
201127240
—
IN
01
—
611077369001
HEALTHNET
—
05
—
7100186320
—
KY
Enumeration date
11/17/2011
Last updated
12/05/2014
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