Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 25802 | TN |
NPI | 1235692872 |
---|---|
Provider Name | Angela Warren |
First Address | Bartlett, TN 38133-8902 |
Second Address | Memphis, TN 38103-2816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 10/04/2019 |