| NPI | 1992068878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA BAKERINK Director, Provider Enrollment 865-500-1325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 208M00000X Hospitalist |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2012-06-16 |
| Last Update Date | 2025-02-26 |