| NPI | 1164965778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA L MONDRAGE Secretary/Treasurer 615-481-0283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |