| NPI | 1487096376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET H BONIFACIO Owner/Provider 865-387-2904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN APM0000017637) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2019-04-12 |