Provider Demographics
NPI:1053501015
Name:MOOBERRY, REBECCA (CRNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MOOBERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6197
Mailing Address - Country:US
Mailing Address - Phone:615-685-1283
Mailing Address - Fax:615-665-0755
Practice Address - Street 1:20 BURTON HILLS BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6197
Practice Address - Country:US
Practice Address - Phone:615-685-1283
Practice Address - Fax:615-665-0755
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC077695367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered