Provider Demographics
NPI:1346613643
Name:HUMMEL, MATHEW JACOB SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:JACOB SCOTT
Last Name:HUMMEL
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 1:1301 MEDICAL CENTER DR
Mailing Address - Street 2:VUMC ANESTHESIOLOGY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0004
Practice Address - Country:US
Practice Address - Phone:859-323-5956
Practice Address - Fax:859-323-5956
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012050367500000X
TN180058163WC0200X
TNAPN20708367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine