Provider Demographics
NPI:1750395885
Name:BROTHERS, TERRI LEE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LEE
Last Name:BROTHERS
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 1:9940 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-3550
Mailing Address - Country:US
Mailing Address - Phone:423-842-2881
Mailing Address - Fax:423-843-3901
Practice Address - Street 1:9940 SHORE DR
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-3550
Practice Address - Country:US
Practice Address - Phone:423-842-2881
Practice Address - Fax:423-843-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000009211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3607844Medicaid
TN3625178Medicare ID - Type Unspecified
TN3607844Medicaid