Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 54034 | TN |
NPI | 1265589139 |
---|---|
Provider Name | Alpa M Nick |
First Address | Nashville, TN 37203 |
Second Address | Nashville, TN 37203-2650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 10/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100506970 | (05) | KY |
Q020218 | (05) | TN |