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Marty Dale Wallace, CRNA
Certified Registered Nurse Anesthetist in Johnson City, Tennessee
NPI 1164674743

Marty Dale Wallace is a Certified Registered Nurse Anesthetist based in Johnson City, TN. Marty Dale Wallace practices in Johnson City, TN and has the professional credentials of CRNA. The NPI Number for Marty Dale Wallace is 1164674743 and holds a License No. APN13700 (Tennessee).

The current practice location address for Marty Dale Wallace is 1114 Sunset Dr, Johnson City, TN and can be reached out via phone at 423-283-0776 and via fax at 423-283-0549.

Location: 1114 Sunset Dr, Johnson City, TN, 37602-3727
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1164674743
Provider Name
Marty Dale Wallace
Credential
CRNA
Provider Entity Type
Individual
Gender
Male
Address
1114 Sunset Dr, Johnson City, TN, 37602-3727
Phone Number
423-283-0776
Fax Number
423-283-0549
Provider Enumeration Date
10/15/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1510077 05 TN
institution
Provider Business Practice Location Address Details
Address
1114 Sunset Dr
City
Johnson City
State
Tennessee
Zip
37604-2969
Phone Number
423-283-0776
Fax Number
423-283-0549
person
Provider Business Mailing Address Details
Address
1114 Sunset Dr
City
Johnson City
State
Tennessee
Zip
37604-2969
Phone Number
423-283-0776
Fax Number
423-283-0549
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Anesthetist, Certified Registered
Speciality
-
Taxonomy
367500000X
License No.
APN13700 (Tennessee)
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
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