Provider Demographics
NPI:1114976495
Name:WESTBROOK, JOHN Q JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:Q
Last Name:WESTBROOK
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4945
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841
Mailing Address - Country:US
Mailing Address - Phone:931-261-7629
Mailing Address - Fax:
Practice Address - Street 1:8797 ALBERTA ST
Practice Address - Street 2:SCOTT COUNTY HOSPITAL
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-569-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN030094367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3602253Medicare ID - Type Unspecified