Individual
WALTER K CONERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
709 MIDDLE CREEK RD, SEVIERVILLE, TN 37862-5047
(952) 442-9770
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0001150027
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3636499
—
TN
01
—
4121942
BLUE CROSS OF TN
TN
Enumeration date
06/01/2006
Last updated
04/29/2008
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