Provider Demographics
NPI:1649912395
Name:DOLCE LILAVOIS, JUDY (CRNA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DOLCE LILAVOIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:DOLCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8418 ROCKCREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4593
Mailing Address - Country:US
Mailing Address - Phone:954-559-1656
Mailing Address - Fax:
Practice Address - Street 1:5545 MURRAY AVE STE 130
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3861
Practice Address - Country:US
Practice Address - Phone:901-682-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000031843207L00000X
TN31843367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty