Basic Information
| Provider Information | |||||||||
| NPI: | 1396785788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDRUS | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 SAUNDERSVILLE RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370758903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8886876133 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 SAUNDERSVILLE RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370758903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8886876133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APN10367 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 10069712 | 01 | TN | AMERIGROUP | OTHER | 4076433 | 01 | TN | BCBS | OTHER | P00148038 | 01 | TN | RAILROAD MEDICARE | OTHER | 74008624 | 01 | KY | KY MEDICAID | OTHER | 3630064 | 05 | TN | MEDICAID |