Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 19977 | TN |
NPI | 1033596218 |
---|---|
Provider Name | Amanda Allen |
First Address | Memphis, TN 38120-9446 |
Second Address | Memphis, TN 38120-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 05/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q024138 | (05) | TN |