Provider Demographics
NPI:1558320655
Name:DRAKE, MARY-JO (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY-JO
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
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 291264
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1264
Mailing Address - Country:US
Mailing Address - Phone:615-620-2330
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:704 HWY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2111
Practice Address - Country:US
Practice Address - Phone:615-441-4504
Practice Address - Fax:615-620-2323
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002039367500000X
TNAPN13743367500000X
TNRN167485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse