Individual
SHANNAN CASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 448-5892
(901) 448-5540
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-7302
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
15207
TN
367500000X
Certified Registered Nurse Anesthetist
RN158239
TN
Other
Enumeration date
07/29/2010
Last updated
05/13/2016
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