Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 23004 | TN |
NPI | 1033632542 |
---|---|
Provider Name | Adam Schreader |
First Address | Ooltewah, TN 37363-9132 |
Second Address | Chattanooga, TN 37403-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 22/08/2017 |