Provider Demographics
NPI:1013092527
Name:NORMAN, SAMUEL RAYMOND (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:RAYMOND
Last Name:NORMAN
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 1:426 LEONARD SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CLARKRANGE
Mailing Address - State:TN
Mailing Address - Zip Code:38553-5036
Mailing Address - Country:US
Mailing Address - Phone:931-863-5444
Mailing Address - Fax:
Practice Address - Street 1:436 CENTRAL AVENUE WEST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-8407
Practice Address - Country:US
Practice Address - Phone:931-879-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered