Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 22433 | TN |
NPI | 1003345398 |
---|---|
Provider Name | Angelica J Dennis |
First Address | Memphis, TN 38104-3415 |
Second Address | Memphis, TN 38104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 08/06/2017 |