| NPI | 1225345275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNA B PETERSON Sole Member 423-341-0629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN11999) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-09-10 |