Provider Demographics
NPI:1639575517
Name:WILLINGHAM, CAROLINE E (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:E
Last Name:WILLINGHAM
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 1:4230 PEPPERS LN
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1578
Mailing Address - Country:US
Mailing Address - Phone:303-746-3581
Mailing Address - Fax:
Practice Address - Street 1:4230 PEPPERS LN
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1578
Practice Address - Country:US
Practice Address - Phone:303-746-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19628367500000X
TN187163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse