Provider Demographics
NPI:1174577696
Name:LANNOM, HARRY GLENN (CRNA)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:GLENN
Last Name:LANNOM
Suffix:
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 1252
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-1252
Mailing Address - Country:US
Mailing Address - Phone:615-396-4464
Mailing Address - Fax:615-396-6748
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-396-4464
Practice Address - Fax:615-396-6748
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN105174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4182581OtherBCBS EFFECTIVE 5/1/08
TN430052095OtherRR MEDICARE
TN3144083OtherBLUE CROSS BLUE SHIELD
TN3628616Medicaid
TN3628616Medicare ID - Type Unspecified